US20160136094A1 - Compositions For Treating Acute, Post-Operative, or Chronic Pain and Methods of Using the Same - Google Patents
Compositions For Treating Acute, Post-Operative, or Chronic Pain and Methods of Using the Same Download PDFInfo
- Publication number
- US20160136094A1 US20160136094A1 US14/938,274 US201514938274A US2016136094A1 US 20160136094 A1 US20160136094 A1 US 20160136094A1 US 201514938274 A US201514938274 A US 201514938274A US 2016136094 A1 US2016136094 A1 US 2016136094A1
- Authority
- US
- United States
- Prior art keywords
- days
- months
- composition
- anticonvulsant agent
- carrier
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- 239000000203 mixture Substances 0.000 title claims abstract description 187
- 208000002193 Pain Diseases 0.000 title claims abstract description 89
- 238000000034 method Methods 0.000 title claims abstract description 74
- 208000004550 Postoperative Pain Diseases 0.000 title claims abstract description 35
- 230000001154 acute effect Effects 0.000 title claims abstract description 35
- 208000005298 acute pain Diseases 0.000 title claims abstract description 35
- 208000000094 Chronic Pain Diseases 0.000 title claims abstract description 34
- 230000002980 postoperative effect Effects 0.000 title claims description 22
- 239000001961 anticonvulsive agent Substances 0.000 claims abstract description 149
- 229940125681 anticonvulsant agent Drugs 0.000 claims abstract description 138
- 230000036407 pain Effects 0.000 claims abstract description 20
- 239000011859 microparticle Substances 0.000 claims description 48
- 229960000623 carbamazepine Drugs 0.000 claims description 36
- FFGPTBGBLSHEPO-UHFFFAOYSA-N carbamazepine Chemical compound C1=CC2=CC=CC=C2N(C(=O)N)C2=CC=CC=C21 FFGPTBGBLSHEPO-UHFFFAOYSA-N 0.000 claims description 36
- 210000005036 nerve Anatomy 0.000 claims description 29
- -1 poly(ethylene glycol) Polymers 0.000 claims description 25
- 239000002105 nanoparticle Substances 0.000 claims description 23
- 229920001606 poly(lactic acid-co-glycolic acid) Polymers 0.000 claims description 22
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 claims description 21
- UGJMXCAKCUNAIE-UHFFFAOYSA-N Gabapentin Chemical compound OC(=O)CC1(CN)CCCCC1 UGJMXCAKCUNAIE-UHFFFAOYSA-N 0.000 claims description 18
- 239000007864 aqueous solution Substances 0.000 claims description 15
- 229920000642 polymer Polymers 0.000 claims description 15
- 238000004945 emulsification Methods 0.000 claims description 14
- 229920001223 polyethylene glycol Polymers 0.000 claims description 14
- 210000003497 sciatic nerve Anatomy 0.000 claims description 14
- 230000008020 evaporation Effects 0.000 claims description 12
- 210000002381 plasma Anatomy 0.000 claims description 12
- 210000000578 peripheral nerve Anatomy 0.000 claims description 11
- 230000036470 plasma concentration Effects 0.000 claims description 11
- 230000001953 sensory effect Effects 0.000 claims description 11
- 239000002904 solvent Substances 0.000 claims description 11
- 238000000935 solvent evaporation Methods 0.000 claims description 11
- 238000000638 solvent extraction Methods 0.000 claims description 11
- 229960001233 pregabalin Drugs 0.000 claims description 10
- AYXYPKUFHZROOJ-ZETCQYMHSA-N pregabalin Chemical compound CC(C)C[C@H](CN)CC(O)=O AYXYPKUFHZROOJ-ZETCQYMHSA-N 0.000 claims description 10
- 230000009885 systemic effect Effects 0.000 claims description 10
- CXOFVDLJLONNDW-UHFFFAOYSA-N Phenytoin Chemical compound N1C(=O)NC(=O)C1(C=1C=CC=CC=1)C1=CC=CC=C1 CXOFVDLJLONNDW-UHFFFAOYSA-N 0.000 claims description 9
- 229920001577 copolymer Polymers 0.000 claims description 9
- 229960002870 gabapentin Drugs 0.000 claims description 9
- 229960002036 phenytoin Drugs 0.000 claims description 9
- 238000004519 manufacturing process Methods 0.000 claims description 8
- 210000003099 femoral nerve Anatomy 0.000 claims description 7
- 208000004296 neuralgia Diseases 0.000 claims description 7
- 210000003901 trigeminal nerve Anatomy 0.000 claims description 7
- KJADKKWYZYXHBB-XBWDGYHZSA-N Topiramic acid Chemical compound C1O[C@@]2(COS(N)(=O)=O)OC(C)(C)O[C@H]2[C@@H]2OC(C)(C)O[C@@H]21 KJADKKWYZYXHBB-XBWDGYHZSA-N 0.000 claims description 6
- 210000003461 brachial plexus Anatomy 0.000 claims description 6
- 208000014674 injury Diseases 0.000 claims description 6
- 238000007918 intramuscular administration Methods 0.000 claims description 6
- 239000003589 local anesthetic agent Substances 0.000 claims description 6
- 210000002988 lumbosacral plexus Anatomy 0.000 claims description 6
- 210000002698 mandibular nerve Anatomy 0.000 claims description 6
- 229960001816 oxcarbazepine Drugs 0.000 claims description 6
- CTRLABGOLIVAIY-UHFFFAOYSA-N oxcarbazepine Chemical compound C1C(=O)C2=CC=CC=C2N(C(=O)N)C2=CC=CC=C21 CTRLABGOLIVAIY-UHFFFAOYSA-N 0.000 claims description 6
- 229960004394 topiramate Drugs 0.000 claims description 6
- 210000002517 zygapophyseal joint Anatomy 0.000 claims description 6
- 238000001556 precipitation Methods 0.000 claims description 5
- 230000008569 process Effects 0.000 claims description 5
- 238000001694 spray drying Methods 0.000 claims description 5
- 210000001519 tissue Anatomy 0.000 claims description 5
- 208000006820 Arthralgia Diseases 0.000 claims description 4
- 206010037779 Radiculopathy Diseases 0.000 claims description 4
- 201000010099 disease Diseases 0.000 claims description 4
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 claims description 4
- 239000003937 drug carrier Substances 0.000 claims description 4
- 238000002296 dynamic light scattering Methods 0.000 claims description 4
- 239000000546 pharmaceutical excipient Substances 0.000 claims description 4
- 238000007873 sieving Methods 0.000 claims description 4
- 210000003594 spinal ganglia Anatomy 0.000 claims description 4
- 208000008035 Back Pain Diseases 0.000 claims description 3
- 206010064888 Cervicogenic headache Diseases 0.000 claims description 3
- 208000006561 Cluster Headache Diseases 0.000 claims description 3
- 208000019695 Migraine disease Diseases 0.000 claims description 3
- 206010027603 Migraine headaches Diseases 0.000 claims description 3
- 206010036313 Post-traumatic headache Diseases 0.000 claims description 3
- 206010036376 Postherpetic Neuralgia Diseases 0.000 claims description 3
- 206010044652 trigeminal neuralgia Diseases 0.000 claims description 3
- 206010058019 Cancer Pain Diseases 0.000 claims description 2
- 208000023890 Complex Regional Pain Syndromes Diseases 0.000 claims description 2
- 208000007514 Herpes zoster Diseases 0.000 claims description 2
- 208000003618 Intervertebral Disc Displacement Diseases 0.000 claims description 2
- 206010068106 Occipital neuralgia Diseases 0.000 claims description 2
- 208000008765 Sciatica Diseases 0.000 claims description 2
- 206010003074 arachnoiditis Diseases 0.000 claims description 2
- 230000003412 degenerative effect Effects 0.000 claims description 2
- 206010012601 diabetes mellitus Diseases 0.000 claims description 2
- 208000021722 neuropathic pain Diseases 0.000 claims description 2
- 201000001119 neuropathy Diseases 0.000 claims description 2
- 230000007823 neuropathy Effects 0.000 claims description 2
- 208000033808 peripheral neuropathy Diseases 0.000 claims description 2
- 206010061928 radiculitis Diseases 0.000 claims description 2
- 208000005198 spinal stenosis Diseases 0.000 claims description 2
- 230000008733 trauma Effects 0.000 claims description 2
- 229920000747 poly(lactic acid) Polymers 0.000 claims 2
- 229940065514 poly(lactide) Drugs 0.000 claims 2
- 239000003795 chemical substances by application Substances 0.000 abstract description 41
- 230000001684 chronic effect Effects 0.000 abstract description 6
- 238000002347 injection Methods 0.000 description 19
- 239000007924 injection Substances 0.000 description 19
- 230000000694 effects Effects 0.000 description 14
- 230000001225 therapeutic effect Effects 0.000 description 13
- 238000011282 treatment Methods 0.000 description 12
- 230000001773 anti-convulsant effect Effects 0.000 description 11
- 229960003965 antiepileptics Drugs 0.000 description 11
- 239000003814 drug Substances 0.000 description 10
- 238000001356 surgical procedure Methods 0.000 description 10
- 238000004458 analytical method Methods 0.000 description 8
- 239000000969 carrier Substances 0.000 description 8
- 229940079593 drug Drugs 0.000 description 8
- 238000002360 preparation method Methods 0.000 description 8
- 238000012384 transportation and delivery Methods 0.000 description 8
- 238000007726 management method Methods 0.000 description 7
- AEMRFAOFKBGASW-UHFFFAOYSA-N Glycolic acid Chemical compound OCC(O)=O AEMRFAOFKBGASW-UHFFFAOYSA-N 0.000 description 6
- 239000000872 buffer Substances 0.000 description 6
- 238000013270 controlled release Methods 0.000 description 6
- 238000009472 formulation Methods 0.000 description 6
- 239000011159 matrix material Substances 0.000 description 6
- 230000004048 modification Effects 0.000 description 6
- 238000012986 modification Methods 0.000 description 6
- 239000002245 particle Substances 0.000 description 6
- 239000012071 phase Substances 0.000 description 6
- 239000000243 solution Substances 0.000 description 6
- 239000000725 suspension Substances 0.000 description 6
- 230000002459 sustained effect Effects 0.000 description 6
- 229920002988 biodegradable polymer Polymers 0.000 description 5
- 239000004621 biodegradable polymer Substances 0.000 description 5
- 238000006065 biodegradation reaction Methods 0.000 description 5
- 238000005259 measurement Methods 0.000 description 5
- 239000007787 solid Substances 0.000 description 5
- 208000004454 Hyperalgesia Diseases 0.000 description 4
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 4
- 208000027418 Wounds and injury Diseases 0.000 description 4
- 230000006378 damage Effects 0.000 description 4
- 238000010348 incorporation Methods 0.000 description 4
- JVTAAEKCZFNVCJ-UHFFFAOYSA-N lactic acid Chemical compound CC(O)C(O)=O JVTAAEKCZFNVCJ-UHFFFAOYSA-N 0.000 description 4
- 239000007788 liquid Substances 0.000 description 4
- 239000008194 pharmaceutical composition Substances 0.000 description 4
- 229920001610 polycaprolactone Polymers 0.000 description 4
- 229920002451 polyvinyl alcohol Polymers 0.000 description 4
- 230000000087 stabilizing effect Effects 0.000 description 4
- 239000000126 substance Substances 0.000 description 4
- 239000004094 surface-active agent Substances 0.000 description 4
- LEBVLXFERQHONN-UHFFFAOYSA-N 1-butyl-N-(2,6-dimethylphenyl)piperidine-2-carboxamide Chemical compound CCCCN1CCCCC1C(=O)NC1=C(C)C=CC=C1C LEBVLXFERQHONN-UHFFFAOYSA-N 0.000 description 3
- YMWUJEATGCHHMB-UHFFFAOYSA-N Dichloromethane Chemical compound ClCCl YMWUJEATGCHHMB-UHFFFAOYSA-N 0.000 description 3
- LFQSCWFLJHTTHZ-UHFFFAOYSA-N Ethanol Chemical compound CCO LFQSCWFLJHTTHZ-UHFFFAOYSA-N 0.000 description 3
- XEKOWRVHYACXOJ-UHFFFAOYSA-N Ethyl acetate Chemical compound CCOC(C)=O XEKOWRVHYACXOJ-UHFFFAOYSA-N 0.000 description 3
- 241000700159 Rattus Species 0.000 description 3
- 239000004480 active ingredient Substances 0.000 description 3
- 239000013543 active substance Substances 0.000 description 3
- 230000015556 catabolic process Effects 0.000 description 3
- 238000006731 degradation reaction Methods 0.000 description 3
- 239000002270 dispersing agent Substances 0.000 description 3
- 238000009826 distribution Methods 0.000 description 3
- 238000011156 evaluation Methods 0.000 description 3
- 230000007774 longterm Effects 0.000 description 3
- 230000007170 pathology Effects 0.000 description 3
- 239000008177 pharmaceutical agent Substances 0.000 description 3
- 210000001044 sensory neuron Anatomy 0.000 description 3
- 239000003381 stabilizer Substances 0.000 description 3
- 239000000375 suspending agent Substances 0.000 description 3
- 210000000225 synapse Anatomy 0.000 description 3
- 238000013519 translation Methods 0.000 description 3
- 239000011800 void material Substances 0.000 description 3
- 101000911782 Drosophila melanogaster Hsc70-interacting protein 2 Proteins 0.000 description 2
- 208000003098 Ganglion Cysts Diseases 0.000 description 2
- 206010061218 Inflammation Diseases 0.000 description 2
- 208000005400 Synovial Cyst Diseases 0.000 description 2
- 239000007900 aqueous suspension Substances 0.000 description 2
- 229960003150 bupivacaine Drugs 0.000 description 2
- 210000004027 cell Anatomy 0.000 description 2
- 239000003153 chemical reaction reagent Substances 0.000 description 2
- 230000000295 complement effect Effects 0.000 description 2
- 239000008367 deionised water Substances 0.000 description 2
- 229910021641 deionized water Inorganic materials 0.000 description 2
- 238000001514 detection method Methods 0.000 description 2
- 238000009792 diffusion process Methods 0.000 description 2
- 238000002224 dissection Methods 0.000 description 2
- 239000000839 emulsion Substances 0.000 description 2
- 238000011540 hip replacement Methods 0.000 description 2
- 239000000017 hydrogel Substances 0.000 description 2
- 239000007943 implant Substances 0.000 description 2
- 230000004054 inflammatory process Effects 0.000 description 2
- 235000014655 lactic acid Nutrition 0.000 description 2
- 239000004310 lactic acid Substances 0.000 description 2
- 239000004530 micro-emulsion Substances 0.000 description 2
- 239000004005 microsphere Substances 0.000 description 2
- 239000000178 monomer Substances 0.000 description 2
- BQJCRHHNABKAKU-KBQPJGBKSA-N morphine Chemical compound O([C@H]1[C@H](C=C[C@H]23)O)C4=C5[C@@]12CCN(C)[C@@H]3CC5=CC=C4O BQJCRHHNABKAKU-KBQPJGBKSA-N 0.000 description 2
- 239000003921 oil Substances 0.000 description 2
- 229940005483 opioid analgesics Drugs 0.000 description 2
- 239000003960 organic solvent Substances 0.000 description 2
- 230000004983 pleiotropic effect Effects 0.000 description 2
- 239000003755 preservative agent Substances 0.000 description 2
- 230000004044 response Effects 0.000 description 2
- 239000000523 sample Substances 0.000 description 2
- 238000001878 scanning electron micrograph Methods 0.000 description 2
- 238000012453 sprague-dawley rat model Methods 0.000 description 2
- 239000008223 sterile water Substances 0.000 description 2
- 150000003431 steroids Chemical class 0.000 description 2
- 229940124597 therapeutic agent Drugs 0.000 description 2
- 239000002562 thickening agent Substances 0.000 description 2
- 231100000419 toxicity Toxicity 0.000 description 2
- 230000001988 toxicity Effects 0.000 description 2
- 239000003981 vehicle Substances 0.000 description 2
- IIZPXYDJLKNOIY-JXPKJXOSSA-N 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine Chemical compound CCCCCCCCCCCCCCCC(=O)OC[C@H](COP([O-])(=O)OCC[N+](C)(C)C)OC(=O)CCC\C=C/C\C=C/C\C=C/C\C=C/CCCCC IIZPXYDJLKNOIY-JXPKJXOSSA-N 0.000 description 1
- VHRSUDSXCMQTMA-PJHHCJLFSA-N 6alpha-methylprednisolone Chemical compound C([C@@]12C)=CC(=O)C=C1[C@@H](C)C[C@@H]1[C@@H]2[C@@H](O)C[C@]2(C)[C@@](O)(C(=O)CO)CC[C@H]21 VHRSUDSXCMQTMA-PJHHCJLFSA-N 0.000 description 1
- 235000019489 Almond oil Nutrition 0.000 description 1
- 108010087765 Antipain Proteins 0.000 description 1
- 208000032467 Aplastic anaemia Diseases 0.000 description 1
- OYPRJOBELJOOCE-UHFFFAOYSA-N Calcium Chemical compound [Ca] OYPRJOBELJOOCE-UHFFFAOYSA-N 0.000 description 1
- 206010012335 Dependence Diseases 0.000 description 1
- 206010012735 Diarrhoea Diseases 0.000 description 1
- 208000003164 Diplopia Diseases 0.000 description 1
- 108090000371 Esterases Proteins 0.000 description 1
- 206010015548 Euthanasia Diseases 0.000 description 1
- 208000010201 Exanthema Diseases 0.000 description 1
- 206010020772 Hypertension Diseases 0.000 description 1
- 206010021036 Hyponatraemia Diseases 0.000 description 1
- 229930010555 Inosine Natural products 0.000 description 1
- UGQMRVRMYYASKQ-KQYNXXCUSA-N Inosine Chemical compound O[C@@H]1[C@H](O)[C@@H](CO)O[C@H]1N1C2=NC=NC(O)=C2N=C1 UGQMRVRMYYASKQ-KQYNXXCUSA-N 0.000 description 1
- 206010023126 Jaundice Diseases 0.000 description 1
- 235000010643 Leucaena leucocephala Nutrition 0.000 description 1
- 240000007472 Leucaena leucocephala Species 0.000 description 1
- FYYHWMGAXLPEAU-UHFFFAOYSA-N Magnesium Chemical compound [Mg] FYYHWMGAXLPEAU-UHFFFAOYSA-N 0.000 description 1
- 241001465754 Metazoa Species 0.000 description 1
- 206010028813 Nausea Diseases 0.000 description 1
- 206010030302 Oliguria Diseases 0.000 description 1
- 229920001244 Poly(D,L-lactide) Polymers 0.000 description 1
- 229920006022 Poly(L-lactide-co-glycolide)-b-poly(ethylene glycol) Polymers 0.000 description 1
- 229920000436 Poly(lactide-co-glycolide)-block-poly(ethylene glycol)-block-poly(lactide-co-glycolide) Polymers 0.000 description 1
- 229920000458 Polyglycolide-block-poly(ethylene glycol)-block-polyglycolide Polymers 0.000 description 1
- 229920000432 Polylactide-block-poly(ethylene glycol)-block-polylactide Polymers 0.000 description 1
- 229920002651 Polysorbate 85 Polymers 0.000 description 1
- 206010039897 Sedation Diseases 0.000 description 1
- 208000002847 Surgical Wound Diseases 0.000 description 1
- 208000012886 Vertigo Diseases 0.000 description 1
- 206010047700 Vomiting Diseases 0.000 description 1
- DPXJVFZANSGRMM-UHFFFAOYSA-N acetic acid;2,3,4,5,6-pentahydroxyhexanal;sodium Chemical compound [Na].CC(O)=O.OCC(O)C(O)C(O)C(O)C=O DPXJVFZANSGRMM-UHFFFAOYSA-N 0.000 description 1
- 230000009471 action Effects 0.000 description 1
- 239000000654 additive Substances 0.000 description 1
- 239000008168 almond oil Substances 0.000 description 1
- 210000003484 anatomy Anatomy 0.000 description 1
- 229940035674 anesthetics Drugs 0.000 description 1
- 230000003556 anti-epileptic effect Effects 0.000 description 1
- SDNYTAYICBFYFH-TUFLPTIASA-N antipain Chemical compound NC(N)=NCCC[C@@H](C=O)NC(=O)[C@H](C(C)C)NC(=O)[C@H](CCCN=C(N)N)NC(=O)N[C@H](C(O)=O)CC1=CC=CC=C1 SDNYTAYICBFYFH-TUFLPTIASA-N 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 239000013011 aqueous formulation Substances 0.000 description 1
- 239000012736 aqueous medium Substances 0.000 description 1
- 206010003119 arrhythmia Diseases 0.000 description 1
- 230000003542 behavioural effect Effects 0.000 description 1
- 230000004071 biological effect Effects 0.000 description 1
- 229920001400 block copolymer Polymers 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 238000004820 blood count Methods 0.000 description 1
- 210000004556 brain Anatomy 0.000 description 1
- 239000011575 calcium Substances 0.000 description 1
- 229910052791 calcium Inorganic materials 0.000 description 1
- 239000001768 carboxy methyl cellulose Substances 0.000 description 1
- 239000001913 cellulose Substances 0.000 description 1
- 229920002678 cellulose Polymers 0.000 description 1
- 208000015114 central nervous system disease Diseases 0.000 description 1
- 238000005119 centrifugation Methods 0.000 description 1
- 230000008859 change Effects 0.000 description 1
- 208000019902 chronic diarrheal disease Diseases 0.000 description 1
- 238000003776 cleavage reaction Methods 0.000 description 1
- 239000003086 colorant Substances 0.000 description 1
- 210000002808 connective tissue Anatomy 0.000 description 1
- 239000003246 corticosteroid Substances 0.000 description 1
- 238000004132 cross linking Methods 0.000 description 1
- 230000006735 deficit Effects 0.000 description 1
- 239000010432 diamond Substances 0.000 description 1
- 230000003467 diminishing effect Effects 0.000 description 1
- 238000012377 drug delivery Methods 0.000 description 1
- 239000003995 emulsifying agent Substances 0.000 description 1
- 230000002255 enzymatic effect Effects 0.000 description 1
- 206010015037 epilepsy Diseases 0.000 description 1
- 150000002148 esters Chemical class 0.000 description 1
- BEFDCLMNVWHSGT-UHFFFAOYSA-N ethenylcyclopentane Chemical compound C=CC1CCCC1 BEFDCLMNVWHSGT-UHFFFAOYSA-N 0.000 description 1
- 238000001704 evaporation Methods 0.000 description 1
- 201000005884 exanthem Diseases 0.000 description 1
- 229940042577 exparel Drugs 0.000 description 1
- 238000002474 experimental method Methods 0.000 description 1
- 239000003925 fat Substances 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 125000000524 functional group Chemical group 0.000 description 1
- ZZUFCTLCJUWOSV-UHFFFAOYSA-N furosemide Chemical compound C1=C(Cl)C(S(=O)(=O)N)=CC(C(O)=O)=C1NCC1=CC=CO1 ZZUFCTLCJUWOSV-UHFFFAOYSA-N 0.000 description 1
- 239000003193 general anesthetic agent Substances 0.000 description 1
- 150000004676 glycans Chemical class 0.000 description 1
- 210000000548 hind-foot Anatomy 0.000 description 1
- 230000003301 hydrolyzing effect Effects 0.000 description 1
- 230000002209 hydrophobic effect Effects 0.000 description 1
- 210000000987 immune system Anatomy 0.000 description 1
- 238000002513 implantation Methods 0.000 description 1
- 238000011065 in-situ storage Methods 0.000 description 1
- 229960003786 inosine Drugs 0.000 description 1
- 230000003993 interaction Effects 0.000 description 1
- 238000007913 intrathecal administration Methods 0.000 description 1
- 150000002500 ions Chemical class 0.000 description 1
- 210000003127 knee Anatomy 0.000 description 1
- 238000013150 knee replacement Methods 0.000 description 1
- 239000000787 lecithin Substances 0.000 description 1
- 235000010445 lecithin Nutrition 0.000 description 1
- 229940067606 lecithin Drugs 0.000 description 1
- 210000000265 leukocyte Anatomy 0.000 description 1
- 239000012669 liquid formulation Substances 0.000 description 1
- 229960005015 local anesthetics Drugs 0.000 description 1
- 210000003141 lower extremity Anatomy 0.000 description 1
- 239000011777 magnesium Substances 0.000 description 1
- 229910052749 magnesium Inorganic materials 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 230000007246 mechanism Effects 0.000 description 1
- 239000002609 medium Substances 0.000 description 1
- 230000003340 mental effect Effects 0.000 description 1
- 229920000609 methyl cellulose Polymers 0.000 description 1
- 125000002496 methyl group Chemical group [H]C([H])([H])* 0.000 description 1
- 235000010270 methyl p-hydroxybenzoate Nutrition 0.000 description 1
- 239000001923 methylcellulose Substances 0.000 description 1
- 229960004584 methylprednisolone Drugs 0.000 description 1
- 238000002156 mixing Methods 0.000 description 1
- 229960005181 morphine Drugs 0.000 description 1
- 230000008693 nausea Effects 0.000 description 1
- 239000013642 negative control Substances 0.000 description 1
- 238000010984 neurological examination Methods 0.000 description 1
- 210000002569 neuron Anatomy 0.000 description 1
- 239000002687 nonaqueous vehicle Substances 0.000 description 1
- 238000002414 normal-phase solid-phase extraction Methods 0.000 description 1
- 239000007764 o/w emulsion Substances 0.000 description 1
- 235000019198 oils Nutrition 0.000 description 1
- 238000012856 packing Methods 0.000 description 1
- 230000037325 pain tolerance Effects 0.000 description 1
- 230000006320 pegylation Effects 0.000 description 1
- 230000000144 pharmacologic effect Effects 0.000 description 1
- 230000035790 physiological processes and functions Effects 0.000 description 1
- 239000002504 physiological saline solution Substances 0.000 description 1
- 229920000728 polyester Polymers 0.000 description 1
- 239000000244 polyoxyethylene sorbitan monooleate Substances 0.000 description 1
- 235000010482 polyoxyethylene sorbitan monooleate Nutrition 0.000 description 1
- 229920001282 polysaccharide Polymers 0.000 description 1
- 239000005017 polysaccharide Substances 0.000 description 1
- 229920000053 polysorbate 80 Polymers 0.000 description 1
- 229940068968 polysorbate 80 Drugs 0.000 description 1
- 229940113171 polysorbate 85 Drugs 0.000 description 1
- 239000013641 positive control Substances 0.000 description 1
- 239000000843 powder Substances 0.000 description 1
- 239000002243 precursor Substances 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 235000010232 propyl p-hydroxybenzoate Nutrition 0.000 description 1
- QELSKZZBTMNZEB-UHFFFAOYSA-N propylparaben Chemical class CCCOC(=O)C1=CC=C(O)C=C1 QELSKZZBTMNZEB-UHFFFAOYSA-N 0.000 description 1
- 206010037844 rash Diseases 0.000 description 1
- 239000011347 resin Substances 0.000 description 1
- 229920005989 resin Polymers 0.000 description 1
- 230000000630 rising effect Effects 0.000 description 1
- 238000011808 rodent model Methods 0.000 description 1
- 230000007017 scission Effects 0.000 description 1
- 230000036280 sedation Effects 0.000 description 1
- 231100000046 skin rash Toxicity 0.000 description 1
- 239000002002 slurry Substances 0.000 description 1
- 150000003384 small molecules Chemical class 0.000 description 1
- 235000019812 sodium carboxymethyl cellulose Nutrition 0.000 description 1
- 229920001027 sodium carboxymethylcellulose Polymers 0.000 description 1
- 239000011780 sodium chloride Substances 0.000 description 1
- 235000010199 sorbic acid Nutrition 0.000 description 1
- 239000004334 sorbic acid Substances 0.000 description 1
- 229940075582 sorbic acid Drugs 0.000 description 1
- 239000000600 sorbitol Substances 0.000 description 1
- 235000010356 sorbitol Nutrition 0.000 description 1
- 238000003756 stirring Methods 0.000 description 1
- 230000001629 suppression Effects 0.000 description 1
- 230000004083 survival effect Effects 0.000 description 1
- 208000024891 symptom Diseases 0.000 description 1
- 239000006188 syrup Substances 0.000 description 1
- 235000020357 syrup Nutrition 0.000 description 1
- 238000012385 systemic delivery Methods 0.000 description 1
- 230000008685 targeting Effects 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 206010043554 thrombocytopenia Diseases 0.000 description 1
- 231100000331 toxic Toxicity 0.000 description 1
- 230000002588 toxic effect Effects 0.000 description 1
- 230000002110 toxicologic effect Effects 0.000 description 1
- 231100000027 toxicology Toxicity 0.000 description 1
- 210000000427 trigeminal ganglion Anatomy 0.000 description 1
- 238000004704 ultra performance liquid chromatography Methods 0.000 description 1
- 235000015112 vegetable and seed oil Nutrition 0.000 description 1
- 239000008158 vegetable oil Substances 0.000 description 1
- 231100000889 vertigo Toxicity 0.000 description 1
- 239000011345 viscous material Substances 0.000 description 1
- 230000008673 vomiting Effects 0.000 description 1
- 230000036642 wellbeing Effects 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
- A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
- A61K9/1605—Excipients; Inactive ingredients
- A61K9/1629—Organic macromolecular compounds
- A61K9/1641—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, poloxamers
- A61K9/1647—Polyesters, e.g. poly(lactide-co-glycolide)
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
- A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
- A61K31/4164—1,3-Diazoles
- A61K31/4166—1,3-Diazoles having oxo groups directly attached to the heterocyclic ring, e.g. phenytoin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
- A61K47/34—Macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyesters, polyamino acids, polysiloxanes, polyphosphazines, copolymers of polyalkylene glycol or poloxamers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
- A61K9/19—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles lyophilised, i.e. freeze-dried, solutions or dispersions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
- A61K9/50—Microcapsules having a gas, liquid or semi-solid filling; Solid microparticles or pellets surrounded by a distinct coating layer, e.g. coated microspheres, coated drug crystals
- A61K9/5005—Wall or coating material
- A61K9/5021—Organic macromolecular compounds
- A61K9/5031—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, poly(lactide-co-glycolide)
Definitions
- compositions, methods, and kits for treating acute, post-operative, or chronic pain in a subject are provided herein.
- Clinical management of acute, post-operative pain, or chronic pain predominantly comprises administration of opioids (e.g. morphine), local anesthetics (e.g. bupivacaine) and/or steroids (e.g. methylprednisolone).
- opioids e.g. morphine
- local anesthetics e.g. bupivacaine
- steroids e.g. methylprednisolone
- Traditional methods of acute pain management often necessitate longer hospitalization or clinical care.
- Long-term, systemic use of opioids has well-established side effects, including addiction, thus, alternatives to their use in the management of acute and/or post-operative pain is clinically desired.
- Extended, local delivery of anesthetics e.g. bupivacaine
- Toxicity also limits therapeutic regiments of steroids for management of chronic pain indications.
- Anticonvulsants have been shown to be useful in the treatment and management of many pain indications, as this class of drugs is known to exert important biochemical effects on nerve cells. Such effects reduce the tendency for nerves to transmit signals, and hence, drugs that have an antiepileptic effect are known to reduce the tendency for nerves to send pain signals to the brain. Most drugs belonging to these classes, however, have short circulation half-lives and considerable side effects including, but not limited to, sedation, vertigo, diplopia, skin rash, nausea, vomiting, chronic diarrhea, aplastic anemia, thrombocytopenia, jaundice, oliguria, hypertension, cardiac dysrhythmias, chronic suppression of white blood cell counts, and hyponatremia.
- formulations comprising, consisting of, or consisting essentially of anticonvulsant agents that can provide desirable release profiles and that possess physical characteristics that are consistent with clinical translation as an injectable.
- compositions for treating acute, post-operative, or chronic pain in a subject comprise an anticonvulsant agent and a biodegradable carrier.
- the compositions consist of an anticonvulsant agent and a biodegradable carrier.
- the compositions consist essentially of an anticonvulsant agent and a biodegradable carrier.
- compositions comprising, consisting of, or consisting essentially of an anticonvulsant agent and a biodegradable carrier are also disclosed herein.
- kits for producing compositions for treating acute, post-operative, or chronic pain in a subject are provided.
- FIG. 1 illustrates an exemplary biodegradable, polymeric nanoparticle or microparticle releasing an anticonvulsant agent.
- FIG. 2 shows a representative scanning electron micrograph (SEM) of poly(D,L-lactide-co-glycolide) (PLGA) microparticles incorporating the anticonvulsant carbamazepine fabricated by solvent extraction/evaporation, single oil-in-water emulsification.
- SEM scanning electron micrograph
- FIG. 4 shows examples of sustained, controlled release kinetic profiles of the anticonvulsant carbamazepine from PLGA microparticles comprising 50:50 PLGA with inherent viscosities of (a) 0.15-0.25 dL/g and (b) 0.55-0.75 dL/g.
- FIG. 5 shows examples of sustained, controlled release kinetic profiles of the anticonvulsant carbamazepine from PLGA microparticles comprising 65:35 PLGA with inherent viscosities of (a) 0.55-0.75 dL/g.
- FIG. 6 shows an example of a sustained, controlled release kinetic profile of the anticonvulsant carbamazepine from poly(D,L-lactide) (PLA) microparticles comprising PLA with a molecular weight of 75-120 kDa.
- PLA poly(D,L-lactide)
- FIG. 7 shows the evaluation of therapeutic efficacy of sciatic nerve block following perineural, depot injection of carbamazepine-loaded microparticles.
- FIG. 8 shows pharmacokinetic analysis of the carbamazepine released from the microparticle depot into circulation.
- compositions, methods, and kits may be understood more readily by reference to the following detailed description taken in connection with the accompanying figures, which form a part of this disclosure. It is to be understood that the disclosed compositions, methods, and kits are not limited to the specific compositions, methods, and kits described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed compositions, methods, and kits. Also, as used in the specification including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise.
- compositions, methods, and kits which are, for clarity, described herein in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the disclosed compositions, methods, and kits that are, for brevity, described in the context of a single embodiment, may also be provided separately or in any subcombination.
- administering to said subject and similar terms indicate a procedure by which the described anticonvulsant agents or compositions, together or separately, are introduced into, implanted in, injected into, or applied onto a subject such that target cells, tissues, or segments of the body of the subject are contacted with the agent.
- the terms “near” and “around” when used in reference to the site of administration of the described anticonvulsant agents or compositions should be understood by those skilled in the art to mean administered to the anatomical area of interest within the limits of traditionally practiced surgical and image-guided surgical procedures.
- administration “near” the relevant anatomical site refers to a location that is not directly within or on the site, but sufficiently close to the site to provide a therapeutically relevant effect thereon.
- Those of ordinary skill in the art can readily determine the maximum distance from a given anatomical site that will be sufficient to provide a therapeutically relevant effect using a composition according to the present disclosure having a known concentration of active ingredient.
- a substance is “biodegradable” if it is capable of being at least partially broken down within and cleared by the human body over time by natural biological, biochemical, and/or physiological processes.
- carriers comprising polyesters, such as, poly(lactide-co-glycosides) (PLGA), poly(lactides) (PLA), or copolymers of PLGA or PLA with poly(ethylene glycol) (PEG), which are broken down by the human body by hydrolytic and enzymatic cleavage, through interaction with water and esterases, respectively, are thus referred to as biodegradable carriers.
- “Pharmaceutically acceptable” refers to those properties and substances which are acceptable to the patient from a pharmacological/toxicological point of view and to the manufacturing pharmaceutical chemist from a physical/chemical point of view regarding composition, formulation, stability, patient acceptance, and bioavailability.
- “Pharmaceutically acceptable carrier” refers to a medium that does not interfere with the effectiveness of the biological activity of the active ingredient(s) and is not toxic to the host to which it is administered.
- “Therapeutically effective dose” refers to an amount of a composition, as described herein, effective to achieve a particular biological or therapeutic result such as, but not limited to, biological or therapeutic results disclosed, described, or exemplified herein.
- the therapeutically effective dose may vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the composition to cause a desired response in a subject. Such results may include, but are not limited to, the treatment of acute, post-operative or chronic pain, as determined by any means suitable in the art.
- treating refers to any success or indicia of success in the attenuation or amelioration of an injury, pathology or condition, including any objective or subjective parameter such as abatement, remission, diminishing of symptoms or making the injury, pathology, or condition more tolerable to the patient, slowing in the rate of inflammation, making the final point of inflammation less debilitating, improving a subject's physical or mental well-being, or prolonging the length of survival.
- the treatment may be assessed by objective or subjective parameters; including the results of a physical examination, neurological examination, or psychiatric evaluations.
- “exposed on the surface” means that at least a portion of the anticonvulsant agent is not covered or encased by the biodegradable carrier and is accessible from the exterior of the biodegradable carrier.
- the anticonvulsant agent exposed on the surface can be fully exposed, such that the entire agent is on the surface of the biodegradable carrier, or can be partially exposed, such that only a portion of the agent is on the surface of the biodegradable carrier.
- the anticonvulsant agent that is exposed on the surface of the biodegradable carrier can be bound to the surface of the biodegradable carrier through, for example, covalent or non-covalent bonds, or can be incorporated within the biodegradable carrier such that a portion of the agent is exposed on the surface.
- the anticonvulsant agent is at least partially covered by, contained within, encased in, or entrapped by the biodegradable carrier. In such circumstances, the anticonvulsant agent may or may not be exposed on the surface of the biodegradable carrier. Depending on the type of biodegradable carrier present in the composition, the anticonvulsant agent may be located in a void space, such as a core, of the biodegradable carrier or dispersed within the biodegradable carrier with the potential for being exposed on the surface, or any combination thereof. In some embodiments, the anticonvulsant agent can be dispersed or distributed within the biodegradable carrier, and not partially exposed on the surface of the biodegradable carrier.
- the anticonvulsant agent can be partially exposed on the surface of the biodegradable carrier. In other embodiments, the anticonvulsant agent can be both dispersed or distributed within the biodegradable carrier and partially exposed on the surface of the biodegradable carrier. In yet other embodiments, the anticonvulsant agent can be located in a void space of the biodegradable carrier. In yet other embodiments, the anticonvulsant agent can be both located in a void space of the biodegradable carrier and exposed on the surface of the biodegradable carrier.
- Biodegradable, polymeric microparticles and nanoparticles represent an attractive means to achieve the desired local delivery of therapeutic agents, often by administration of a depot formulation.
- These particles can be fabricated by a variety of techniques to incorporate neurologically active therapeutic agents, including, anticonvulsants.
- the fabrication technique dictates the physical, chemical, and mechanical properties of the resulting particles.
- the fabrication technique and polymer must be selected appropriately.
- buoyant poly(D,L-lactide-co-glycolide) (PLGA) microspheres were created by oil-in-oil emulsification to encapsulate and deliver hydrophilic small-molecule agents (e.g., inosine) for intrathecal administration for the treatment of central nervous system disorders (WO 2004/047768).
- hydrophilic small-molecule agents e.g., inosine
- the anticonvulsant carbamazepine
- carbamazepine has been studied as a model drug for incorporation within these types of devices [Klose et al., Inter J Pharmaceutics., 2011, 404:75-82; Barakat et al., Drug Deliv., 2006, 13(1):9-18; Pepic et al., J Microencapsulation., 2013, 30(2):151-160]; however, in these reports, the fabrication technique, polymer, and size were not selected appropriately to yield a clinically relevant drug delivery system for the treatment of acute, post-operative, or chronic pain indications.
- the intentional high, micro-scale porosity of the microparticles fabricated by Klose et al. limits the ability for sustained, long-term release applications.
- the carbamazepine within the solid matrix microparticles fabricated by Barakat et al. is predominantly distributed on or within close proximity to the microparticle surface. This predominantly surface-associated carbamazepine gives rise to the observed high initial burst release and inability to sustain the release of therapeutically relevant concentrations.
- Pepic et al. utilized an oil-in-water (o/w) single emulsification technique to fabricate large, porous poly( ⁇ -caprolactone) (PCL) microspheres incorporating carbamazepine.
- the high hydrophobic character and crystallinity of the PCL causes extremely slow biodegradation that is too slow to be clinically relevant as a biodegradable carrier for therapeutic delivery in the treatment of acute, post-operative, or chronic pain indications.
- This slow biodegradation combined with the porosity inherent to the PCL polymer matrix causes the carbamazepine release mechanism to be solely diffusion-based, rather than biodegradation-based, necessitating large particle sizes to extend release. These large particle sizes reported are also impractical for clinical translation as an injectable.
- the carbamazepine within the polymer matrix was observed to be predominantly distributed on or within close proximity to the microparticle surface. This predominantly surface-associated carbamazepine gives rise to the observed high initial burst release and inability to sustain the release of therapeutically relevant concentrations.
- compositions that are formulated specifically to enable 1) control of anticonvulsant agent incorporation, including substantially even distribution throughout the polymer matrix, 2) control over anticonvulsant agent release rate, 3) clinically relevant biodegradation rates, and 4) control over the duration of anticonvulsant agent release at therapeutically efficacious concentrations, including sustained efficacious release for an extended period of time, such as one day or more, from nanoparticles, microparticles, or any combination thereof. Also described herein are methods for using these specifically designed compositions for the treatment of acute, post-operative, or chronic pain.
- compositions that are formulated specifically to enable control over hydrodynamic diameter.
- the hydrodynamic diameter of the biodegradable carrier represents an important characteristic which influences 1) anticonvulsant incorporation, 2) anticonvulsant release rate, 3) biodegradation and clearance rate, 4) administration site residence duration, and 5) the ability to enable clinical administration of the composition as an injectable without necessitating a change to the standard of care.
- compositions for treating acute, post-operative, or chronic pain in a subject comprise an anticonvulsant agent and a biodegradable carrier.
- the compositions consist of an anticonvulsant agent and a biodegradable carrier.
- the compositions consist essentially of an anticonvulsant agent and a biodegradable carrier.
- Suitable biodegradable carriers include, but are not limited to, a nanoparticle, a microparticle, or any combination thereof.
- the biodegradable carrier is a nanoparticle.
- the biodegradable carrier is a microparticle.
- the biodegradable carrier is a nanoparticle.
- the biodegradable carrier is a nanoparticle.
- Suitable classes of nanoparticles or microparticles include, but are not limited to, polymeric. Further, said nanoparticles or microparticles may be solid, hollow, or a mixture thereof. Further, said nanoparticles or microparticles may be porous, wherein the porosity is defined solely by the density and packing arrangement of the polymer matrix and the incorporated anticonvulsant agent.
- Polymeric nanoparticles can have a mean hydrodynamic diameter up to 1 micron, as measured by dynamic light scattering in aqueous solution, wherein the hydrodynamic diameter is derived solely from the fabrication process in the absence of sieving the lyophilized product.
- Suitable instrumentation for aqueous solution phase dynamic light scattering includes the Malvern InstrumentsTM ZetaSizer® Nano ZS, wherein the mean is derived from the intensity distribution obtained with cumulants analysis.
- Polymeric microparticles can have a median and/or mean hydrodynamic diameter greater than or equal to 1 micron and up to about 25 microns, inclusive, as measured by laser diffraction in aqueous solution, wherein the hydrodynamic diameter is derived solely from the fabrication process in the absence of sieving the lyophilized product.
- Suitable instrumentation for aqueous solution phase laser diffraction includes the Malvern InstrumentsTM Mastersizer® 3000 equipped with the Hydro MV unit, where median and mean hydrodynamic diameter are calculated as d[50] and d[3.2], respectively.
- microparticles can be fabricated via solvent extraction/evaporation, single oil-in-water emulsification to have a median hydrodynamic diameter (d[50]) of 18 microns, as measured by laser diffraction in aqueous solution, by precisely controlling the shear-rate and viscosity of the emulsion.
- the disclosed compositions have sufficiently small median and/or mean hydrodynamic diameters up to 25 microns, inclusive, to enable clinical administration as an injectable without changing the standard of care.
- Suitable anticonvulsant agents include, but are not limited to, carbamazepine, pregabalin, phenytoin, gabapentin, topiramate, oxcarbazepine, or any combination thereof.
- the anticonvulsant agent is carbamazepine.
- the anticonvulsant agent is phenytoin.
- the anticonvulsant agent is gabapentin.
- the anticonvulsant agent is pregabalin.
- compositions can comprise, consist of, or consist essentially of an anticonvulsant agent and a biodegradable carrier.
- the composition comprises, consists of, or consists essentially of carbamazepine and a nanoparticle.
- the composition comprises, consists of, or consists essentially of carbamazepine and a microparticle.
- the composition comprises, consists of, or consists essentially of phenytoin and a nanoparticle.
- the composition comprises, consists of, or consists essentially of phenytoin and a microparticle.
- the composition comprises, consists of, or consists essentially of gabapentin and a nanoparticle.
- the composition comprises, consists of, or consists essentially of gabapentin and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of pregabalin and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of pregabalin and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of topiramate and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of topiramate and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of oxcarbazepine and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of oxcarbazepine and a microparticle.
- Anticonvulsant agents also include mixtures of carbamazepine, pregabalin, phenytoin, gabapentin, topiramate, and/or oxcarbazepine within the same biodegradable carrier.
- the composition can comprise carbamazepine and pregabalin within a microparticle.
- the anticonvulsant agent can be formulated to comprise up to 1% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 5% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 10% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 15% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 20% by weight, inclusive, of the biodegradable carrier.
- the anticonvulsant agent can be formulated to comprise up to 25% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 50% by weight, inclusive, of the biodegradable carrier.
- the phrase “the anticonvulsant agent” can refer to more than one anticonvulsant agent if more than one such agent is present in the composition.
- a reference to release of “60% of the anticonvulsant agent” means that there is release of 60% of the sole present anticonvulsant.
- language referring to release of “60% of the anticonvulsant agent” means that 60% of the total complement of anticonvulsant agents is released.
- composition includes 3 mg of a first anticonvulsant agent and 3 mg of a second anticonvulsant agent
- release of “60% of the anticonvulsant agent” can mean that 60% of the total complement of 6 mg of anticonvulsant agents is released.
- Biodegradable carriers can comprise, consist of, or consist essentially of a number of materials suitable for delivering an anticonvulsant agent to a subject, including synthetically derived, biodegradable polymers.
- Exemplary polymers include, but are not limited to, poly(lactides) (PLA), poly(glycolides) (PGA), poly(lactide-co-glycolides) (PLGA), or copolymers of said polymers with poly(ethylene glycol)(PEG), or any combination thereof.
- the biodegradable carrier comprises, consists of, or consists essentially of a synthetically derived biodegradable polymer.
- the synthetically derived biodegradable polymer can be poly(lactic-co-glycolic acid) (PLGA), having a lactic acid and glycolic acid content ranging from 0-100% for each monomer.
- PLGA poly(lactic-co-glycolic acid)
- the biodegradable polymer can be a 50:50 PLGA, where 50:50 refers to the ratio of lactic to glycolic acid.
- the biodegradable carrier comprises, consists of, or consists essentially of a copolymer.
- the biodegradable polymer can be a copolymer of poly(ethylene glycol) (PEG) and poly(lactic-co-glycolic acid) (PLGA), having a lactic acid and glycolic acid content ranging from 0-100% for each monomer.
- PEG poly(ethylene glycol)
- PLGA poly(lactic-co-glycolic acid)
- Biodegradable carriers can be configured to be injected into a subject.
- the biodegradable carrier comprises a nanoparticle that is configured to be injected into a subject.
- the biodegradable carrier comprises a microparticle that is configured to be injected into a subject.
- the microparticle For injection into a subject, the microparticle must have a median and/or mean hydrodynamic diameter of not more than 25 microns, inclusive, as measured by the aforementioned aqueous solution phase laser diffraction instrumentation.
- Biodegradable carriers can also be configured to be implanted into a subject. Implants can be any size and shape suitable for delivering an anticonvulsant to or near the site of pain.
- Biodegradable carriers can further comprise one or more surface modifications.
- suitable surface modification include, but are not limited to, functional group modifications, PEGylation or affinity-based targeting moieties.
- the biodegradable carrier can be PEGylated. Surface modifications can prevent the carrier from migrating from the site of administration, abrogate the foreign body response, and/or minimize clearance by immune system cells.
- the anticonvulsant agent can be exposed on the surface of the biodegradable carrier, incorporated within the biodegradable carrier, or both. In some embodiments, the anticonvulsant agent is incorporated within the biodegradable carrier.
- the process of incorporation may be accomplished using solvent extraction/evaporation, oil-in-water (o/w) single emulsification in the presence of a stabilizing surfactant.
- Suitable surfactants for stabilizing this oil-in-water emulsion include, but are not limited to, poly(vinyl alcohol) (PVA), polysorbate 80, polysorbate 85, poly(ethylene glycol), or any combination thereof.
- exemplary polymers for forming the biodegradable carrier include, but are not limited to, PLGA, PLA, PLGA-PEG and PLA-PEG block copolymers, or any combination thereof.
- the biodegradable carrier for use in an incorporated system can be chosen to begin to degrade within any suitable time frame following preparation for administration of the composition to a subject.
- the biodegradable carrier can begin to degrade upon resuspension in aqueous media.
- the biodegradable carrier can begin to degrade upon administration of the composition to a subject.
- the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 3 hours. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 6 hours. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 12 hours. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 1 day. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 2 days.
- the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 3 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 4 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 5 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 6 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 7 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 8 days.
- the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 9 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 10 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 12 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 14 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 18 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 21 days.
- the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 28 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 35 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 42 days. In some embodiments, the biodegradable carrier releases less than 60%/o of the anticonvulsant agent over about 56 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 3 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 4 months.
- the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 5 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 6 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 7 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 8 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 9 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 10 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 12 months.
- the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 hours. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 6 hours. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 12 hours. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 1 day. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 2 days.
- the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 4 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 5 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 6 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 7 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 8 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 9 days.
- the biodegradable carrier provides a therapeutically effective dose of the agent for up to 10 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 12 days. In some embodiments, the biodegradable carrier provides a therapeutically effect dose of the agent for up to 14 days. In some embodiments, the biodegradable carrier provides a therapeutically effect dose of the agent for up to 18 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 weeks. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 1 month. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 2 months.
- the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 4 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 5 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 6 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 7 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 8 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 9 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 10 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 12 months.
- Degradation of the biodegradable carrier can lead to the controlled release of and/or delivery of the anticonvulsant agent, providing a therapeutically effective dose of the agent to the subject, while maintaining systemic blood plasma concentrations of the anticonvulsant agent that are lower than those associated with oral dosing or administration.
- the blood plasma concentration of the anticonvulsant agent can be 1/1000 or less than the blood plasma concentration associated with oral dosing or administration.
- the blood plasma concentration of the anticonvulsant agent can be 1/500 or less than the blood plasma concentration associated with oral dosing or administration.
- the blood plasma concentration of the anticonvulsant agent can be 1/100 or less than the blood plasma concentration associated with oral dosing or administration.
- the blood plasma concentration of the anticonvulsant agent can be below detection limits of analytical measurements.
- compositions described herein may stabilize the composition, allow it to be readily administered to a subject, increase its ability to treat acute, chronic, or post-operative pain, or otherwise make the composition suitable for therapeutic use in a subject.
- the described composition may further comprise a pharmaceutically acceptable carrier or excipient, as would be known to an individual skilled in the relevant art.
- pharmaceutical compositions having an anticonvulsant and a biodegradable carrier as provided herein.
- the described pharmaceutical compositions for delivery or injection of the described compositions may be administered to a subject in order to maintain the ability to treat chronic pain in the subject over a prolonged period of time. For example, composition viscosity and concentration of the agent may be altered to increase the half-life of composition's active ingredients.
- the described pharmaceutical compositions may be formulated as any of various preparations that are known and suitable in the art, including those described and exemplified herein.
- the pharmaceutical compositions are aqueous formulations.
- Aqueous solutions may be prepared by admixing the described compositions in water or suitable physiologic buffer, and optionally adding suitable colorants, preservatives, stabilizing and thickening agents, ions such as calcium or magnesium, and the like as desired.
- Aqueous suspensions may also be made by dispersing the described compositions in water or physiologic buffer with viscous material, such as natural or synthetic gums, resins, methylcellulose, sodium carboxymethylcellulose, and other well-known suspending agents.
- the suspensions may be formulated by dispersing the present biodegradable carrier and active agent within injectable, in situ cross-linking hydrogel solution precursors, including, but not limited to, naturally derived polymers (e.g. polysaccharides) and/or synthetically derived polymers (e.g. PEG, PGA-PEG-PGA. PLA-PEG-PLA, PLGA-PEG-PLGA).
- injectable, in situ cross-linking hydrogel solution precursors including, but not limited to, naturally derived polymers (e.g. polysaccharides) and/or synthetically derived polymers (e.g. PEG, PGA-PEG-PGA. PLA-PEG-PLA, PLGA-PEG-PLGA).
- a hydrogel may function as an excipient in which the biodegradable carrier and active agent are dispersed.
- compositions may also be prepared as liquid formulations and solid form preparations which are intended to be converted, shortly before use, to liquid preparations.
- liquids include solutions, suspensions, syrups, slurries, and emulsions.
- Liquid preparations may be prepared by conventional means with pharmaceutically acceptable additives such as suspending agents (e.g., sorbitol syrup, cellulose derivatives or hydrogenated edible fats or oils); emulsifying agents (e.g., lecithin or acacia); non-aqueous vehicles (e.g., almond oil, oily esters, or fractionated vegetable oils); and preservatives (e.g., methyl or propyl-p-hydroxybenzoates or sorbic acid).
- suspending agents e.g., sorbitol syrup, cellulose derivatives or hydrogenated edible fats or oils
- emulsifying agents e.g., lecithin or acacia
- non-aqueous vehicles e.g., almond oil
- compositions may contain, in addition to the active agent, stabilizers, buffers, dispersants, thickeners, solubilizing agents, and the like.
- the compositions may be in powder or lyophilized form for constitution with a suitable vehicle such as sterile water, physiological buffer, saline solution, or alcohol, before use.
- the compositions may be formulated for injection into a subject.
- the compositions described may be formulated in aqueous solutions such as water or alcohol, or in physiologically compatible buffers such as Hanks's solution. Ringer's solution, or physiological saline buffer.
- the solution may contain one or more formulatory agents such as suspending, stabilizing or dispersing agents.
- Injection formulations may also be prepared as solid form preparations which are intended to be converted, shortly before use, to liquid form preparations suitable for injection, for example, by constitution with a suitable vehicle, such as sterile water, saline solution, or alcohol before use.
- kits for treating a subject having acute, post-operative, or chronic pain comprising administering to a subject having acute, post-operative, or chronic pain any one of the compositions disclosed herein.
- the methods of treating a subject having acute, post-operative, or chronic pain can comprise administering to a subject having the pain a composition comprising an anticonvulsant agent and a biodegradable carrier.
- the methods of treating a subject having acute, post-operative, or chronic pain can comprise administering to a subject having the pain a composition consisting of an anticonvulsant agent and a biodegradable carrier.
- the methods of treating a subject having acute, post-operative, or chronic pain can comprise administering to a subject having the pain a composition consisting essentially of an anticonvulsant agent and a biodegradable carrier.
- compositions can be administered by injection or implantation.
- the composition can be injected or surgically placed on or near the nerve of interest.
- Local delivery allows a therapeutic concentration of the composition to be delivered to the nerve in question, without the systemic levels, including, but not limited to, blood plasma concentrations, rising as high as when oral or systemic delivery is used for the same effect. Consequently, the systemic side effects can be greatly reduced or entirely eliminated.
- compositions can be injected by a number of routes, including, but not limited to, epidurally, intravenously, intra-arterially, transdermally, subcutaneously, intra-articularly, intramuscularly, perineurally, percutaneously, or any combination thereof.
- routes including, but not limited to, epidurally, intravenously, intra-arterially, transdermally, subcutaneously, intra-articularly, intramuscularly, perineurally, percutaneously, or any combination thereof.
- the compositions can be implanted at or near a site of acute, post-operative, or chronic pain.
- the composition can be administered near or onto a sensory neuron.
- the composition can be injected near or onto a sensory neuron.
- the composition can be surgically implanted near or onto a sensory neuron.
- the composition can be administered near or onto a synapse.
- the composition can be injected near or onto a synapse.
- the composition can be surgically implanted near or onto a synapse.
- the composition can be administered near or onto a dorsal root ganglion.
- the composition can be injected near or onto a dorsal root ganglion.
- the composition can be surgically implanted near or onto a dorsal root ganglion. In yet other embodiments, the composition can be administered near or onto sensory nerve. In some aspects, the composition can be injected near or onto a sensory nerve. In other aspects, the composition can be surgically implanted near or onto a sensory nerve. In yet other embodiments, the composition can be administered near or onto a peripheral nerve. In some aspects, the composition can be injected near or onto a peripheral nerve. In other aspects, the composition can be surgically implanted near or onto a peripheral nerve. In yet other embodiments, the composition can be administered near or onto a medial nerve branch. In some aspects, the composition can be injected near or onto a medial nerve branch.
- the composition can be surgically implanted near or onto a medial nerve branch. In yet other embodiments, the composition can be administered into or around intramuscular tissue. In some aspects, the composition can be injected into or around intramuscular tissue. In other aspects, the composition can be surgically implanted into or around intramuscular tissue. In yet other embodiments, the composition can be administered into or around an intra-articular joint. In some aspects, the composition can be injected into or around an intra-articular joint. In other aspects, the composition can be surgically implanted into or around an intra-articular joint. In yet other embodiments, the composition can be administered into or around a facet joint. In some aspects, the composition can be injected into or around a facet joint.
- the composition can be surgically implanted into or around a facet joint. In yet other embodiments, the composition can be administered near or onto the femoral nerve. In some aspects, the composition can be injected near or onto the femoral nerve. In other aspects, the composition can be surgically implanted near or onto the femoral nerve. In yet other embodiments, the composition can be administered near or onto the sciatic nerve. In some aspects, the composition can be injected near or onto the sciatic nerve. In other aspects, the composition can be surgically implanted near or onto the sciatic nerve. In yet other embodiments, the composition can be administered near or onto the brachial plexus. In some aspects, the composition can be injected near or onto the brachial plexus.
- the composition can be surgically implanted near or onto the brachial plexus. In yet other embodiments, the composition can be administered near or onto the lumbar plexus. In some aspects, the composition can be injected near or onto the lumbar plexus. In other aspects, the composition can be surgically implanted near or onto the lumbar plexus. In yet other embodiments, the composition can be administered into or around the epidural space. In some aspects, the composition can be injected into or around the epidural space. In other aspects, the composition can be surgically implanted into or around the epidural space. In yet other embodiments, the composition can be administered near or onto the inferior alveolar nerve.
- the composition can be injected near or onto the inferior alveolar nerve. In other aspects, the composition can be surgically implanted near or onto the inferior alveolar nerve. In yet other embodiments, the composition can be administered near or onto the trigeminal nerve. In some aspects, the composition can be injected near or onto the trigeminal nerve. In other aspects, the composition can be surgically implanted near or onto the trigeminal nerve.
- the disclosed methods can be used to treat acute, post-operative, or chronic pain caused by a number of ailments, diseases, and/or injuries including, but not limited to pain caused by trauma, post-operative pain, dental pain, degenerative disk disease, spinal stenosis, spinal disc herniation, radiculopathy, radiculitis, arachnoiditis, trigeminal neuralgia, postherpetic neuralgia, shingles, occipital neuralgia, cervicogenic headache, migraine headaches, cluster headaches, back pain, facet joint pain, intra-articular joint pain, intramuscular pain, complex regional pain syndrome, cancer associated pain, neuropathy, diabetic neuropathic pain, tabetic neuralgia, sciatic neuralgia, sciatica, or any combination thereof.
- compositions can be used to treat acute or chronic pain associated with back pain or facet joint pain by, for example, administering the composition on or near the nerve root or the medial branch nerves near the source of the pain.
- compositions can be used to treat chronic pain associated with cervicogenic headache, migraine headaches, and cluster headaches by, for example, administering the composition onto or near the greater occipital nerve.
- compositions can be used to treat chronic pain associated with trigeminal neuralgia and the trigeminal nerve by, for example, administering the composition onto or near the Gasserian ganglion or into Meckel's Cave.
- compositions can be used to treat chronic pain associated with postherpetic neuralgia by, for example, administering the composition onto or near the nerve root, the dorsal nerve root ganglion, or distal to the dorsal nerve root ganglion.
- compositions can be used to treat acute or chronic pain associated with sciatic neuralgia and the sciatic nerve by, for example, administering the composition onto or near the sciatic nerve.
- compositions can be used to treat acute or post-operative pain associated with knee surgery or knee-replacement surgery by, for example, administering the composition onto or near the femoral nerve.
- compositions can be used to treat acute or post-operative pain associated with hip surgery or hip-replacement surgery by, for example, administering the composition onto or near the femoral and/or sciatic nerve.
- compositions can be used to treat acute or post-operative pain associated with hip surgery or hip-replacement surgery by, for example, administering the composition onto or near the lumbar plexus.
- compositions can be used to treat acute or post-operative pain associated with shoulder surgery by, for example, administering the composition onto or near the brachial plexus.
- compositions can be used to treat acute or post-operative pain associated with dental procedures or surgery by, for example, administering the composition onto or near the inferior alveolar nerve or trigeminal nerve.
- Any chronic, acute, or post-operative pain that can be temporarily relieved by a local anesthetic nerve block or corticosteroid injection can potentially be treated long term by delivering the disclosed compositions to the same location that the local anesthetic is applied.
- compositions can be used to treat acute, post-operative, or chronic pain that can be relieved by a sensory and/or peripheral nerve block.
- kits for producing a composition to treat acute, post-operative, or chronic pain in a subject comprising, consisting of, or consisting essentially of an anticonvulsant agent, a biodegradable carrier, and instructions for producing the composition.
- the instructions may describe the steps and reagents for producing the composition by solvent extraction/evaporation, oil-in-water single emulsification, by spray drying, or by precipitation using a solvent/non-solvent system.
- steps and reagents may be in accordance with those that the present application discloses for solvent extraction/evaporation, oil-in-water single emulsification, spray drying, and precipitation using a solvent/non-solvent system.
- Biodegradable, polymeric microparticles were fabricated using a solvent extraction/evaporation, single oil-in-water (o/w) emulsification method.
- PLGA (0-20 wt %) and carbamazepine (0-20 wt %) were dissolved in a suitable, volatile organic solvent (e.g. dichloromethane, ethyl acetate).
- a suitable, volatile organic solvent e.g. dichloromethane, ethyl acetate
- the resulting polymer solution dispersant phase was added to an aqueous continuous phase containing 1-5% (w/v) of surfactant (PVA) under constant shear rate mixing to create a single o/w microemulsion.
- PVA surfactant
- the resulting stable microemulsion was subsequently added to an evaporation bath containing 100 mL of deionized water containing a trace concentration (0-0.5% (w/v)) of surfactant (PVA) under stirring at 350 rpm for 3 hours to effectively extract and evaporate the organic solvent.
- PVA surfactant
- the left common sciatic nerve was exposed by surgical dissection through the biceps femoris.
- Proximal to the trifurcation of the sciatic nerve 8 mm of the nerve was detached from connective tissue.
- Three ligatures (sterile, braided silk suture thread) were tied loosely around the nerve at 1 mm spacings, thus affecting 4-6 mm of the nerve.
- Great care was taken to reproducibly tie the ligatures such that slight constriction of the nerve was achieved when viewed with 40 ⁇ magnification. Following ligation, the surgical incision was closed.
- post-injection 3 hours, 5 hours, and 1, 2, 3, 4, 7, 10, 14, 18, and 21 days
- double-blinded measurements of mechanical allodynia were recorded for subsequent analysis.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Chemical & Material Sciences (AREA)
- Public Health (AREA)
- Epidemiology (AREA)
- Pharmacology & Pharmacy (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Medicinal Chemistry (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Dermatology (AREA)
- Proteomics, Peptides & Aminoacids (AREA)
- Inorganic Chemistry (AREA)
- Medicinal Preparation (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
Abstract
Provided herein are compositions for treating acute, chronic, or post-operative pain in a subject, said compositions comprising an anticonvulsant agent and a biodegradable carrier, wherein the agent is incorporated within the biodegradable carrier. Methods of treating pain in a subject and kits for producing compositions for treating acute, chronic or post-operative pain in in a subject are also disclosed herein.
Description
- The present application is a continuation-in-part of U.S. Ser. No. 14/628,563, filed Feb. 23, 2015, which claims priority to U.S. Provisional Application No. 62/081,162, filed Nov. 18, 2014, the entire contents of both of which are incorporated herein by reference.
- Provided herein are compositions, methods, and kits for treating acute, post-operative, or chronic pain in a subject.
- Clinical management of acute, post-operative pain, or chronic pain predominantly comprises administration of opioids (e.g. morphine), local anesthetics (e.g. bupivacaine) and/or steroids (e.g. methylprednisolone). Traditional methods of acute pain management often necessitate longer hospitalization or clinical care. Long-term, systemic use of opioids has well-established side effects, including addiction, thus, alternatives to their use in the management of acute and/or post-operative pain is clinically desired. Extended, local delivery of anesthetics (e.g. bupivacaine) is effective, however the longevity of this approach is greatly restricted because of inherent toxicity concerns and associated motor deficits. Toxicity also limits therapeutic regiments of steroids for management of chronic pain indications.
- Anticonvulsants have been shown to be useful in the treatment and management of many pain indications, as this class of drugs is known to exert important biochemical effects on nerve cells. Such effects reduce the tendency for nerves to transmit signals, and hence, drugs that have an antiepileptic effect are known to reduce the tendency for nerves to send pain signals to the brain. Most drugs belonging to these classes, however, have short circulation half-lives and considerable side effects including, but not limited to, sedation, vertigo, diplopia, skin rash, nausea, vomiting, chronic diarrhea, aplastic anemia, thrombocytopenia, jaundice, oliguria, hypertension, cardiac dysrhythmias, chronic suppression of white blood cell counts, and hyponatremia. These side effects limit the potential systemic therapeutic use of anticonvulsants for the management of pain. Consequently, physicians cannot always dose enough drug to have the desired anti-pain effect without causing problematic, pleiotropic systemic side effects. Local delivery of anticonvulsants would abrogate these pleiotropic, systemic side effects and enable their therapeutic intervention for the management of pain. For example, a localized injection of a depot formulation of an anticonvulsant agent would permit the use of a lower initial dose than would be required for systemic or oral administration of the agent because the depot would establish therapeutically efficacious concentrations of the agent specifically at the desired site of action.
- There remains an outstanding need for formulations comprising, consisting of, or consisting essentially of anticonvulsant agents that can provide desirable release profiles and that possess physical characteristics that are consistent with clinical translation as an injectable.
- Provided herein are compositions for treating acute, post-operative, or chronic pain in a subject. In some embodiments, the compositions comprise an anticonvulsant agent and a biodegradable carrier. In other embodiments, the compositions consist of an anticonvulsant agent and a biodegradable carrier. In some embodiments, the compositions consist essentially of an anticonvulsant agent and a biodegradable carrier.
- Methods of treating acute, post-operative, or chronic pain comprising administering to a subject having the pain a composition comprising, consisting of, or consisting essentially of an anticonvulsant agent and a biodegradable carrier are also disclosed herein.
- Further provided are kits for producing compositions for treating acute, post-operative, or chronic pain in a subject.
-
FIG. 1 illustrates an exemplary biodegradable, polymeric nanoparticle or microparticle releasing an anticonvulsant agent. -
FIG. 2 shows a representative scanning electron micrograph (SEM) of poly(D,L-lactide-co-glycolide) (PLGA) microparticles incorporating the anticonvulsant carbamazepine fabricated by solvent extraction/evaporation, single oil-in-water emulsification. -
FIG. 3 shows a representative particle size distribution for of PLGA microparticles incorporating the anticonvulsant carbamazepine fabricated by solvent extraction/evaporation, single oil-in-water emulsification, as measured by aqueous solution phase laser diffraction (d[50]=17.5 microns and d[3,2]=10.1 microns, median and mean hydrodynamic diameters, respectively). -
FIG. 4 shows examples of sustained, controlled release kinetic profiles of the anticonvulsant carbamazepine from PLGA microparticles comprising 50:50 PLGA with inherent viscosities of (a) 0.15-0.25 dL/g and (b) 0.55-0.75 dL/g. -
FIG. 5 shows examples of sustained, controlled release kinetic profiles of the anticonvulsant carbamazepine from PLGA microparticles comprising 65:35 PLGA with inherent viscosities of (a) 0.55-0.75 dL/g. -
FIG. 6 shows an example of a sustained, controlled release kinetic profile of the anticonvulsant carbamazepine from poly(D,L-lactide) (PLA) microparticles comprising PLA with a molecular weight of 75-120 kDa. -
FIG. 7 shows the evaluation of therapeutic efficacy of sciatic nerve block following perineural, depot injection of carbamazepine-loaded microparticles. (a) Pain scoring assessed by comparison of pre- and post-treatment electronic von Frey measurements of the ligated hindlimb for treatments of either carbamazepine-loaded microparticles (20 mg, 20 μm, 1.1% carbamazepine by weight, 50:50 PLGA (i.v. 0.55-0.75 dL/g)) (open circle), unloaded microparticles (20 mg, 20 μm, 50:50 PLGA (i.v. 0.55-0.75 dL/g)) (open triangle) or Exparel (150 uL aqueous liposomal suspension, 32 μm) (open square) with soluble carbamazepine (open diamond) and saline (open hexagon). Pain relief scores greater than 1.5 were indicative of therapeutic efficacy. Error analysis is presented as S.E.M. -
FIG. 8 shows pharmacokinetic analysis of the carbamazepine released from the microparticle depot into circulation. The detection limit was 10 ng/mL (dotted grey line). Error analysis is presented as S.D. for n=5 replicates. - The disclosed compositions, methods, and kits may be understood more readily by reference to the following detailed description taken in connection with the accompanying figures, which form a part of this disclosure. It is to be understood that the disclosed compositions, methods, and kits are not limited to the specific compositions, methods, and kits described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed compositions, methods, and kits. Also, as used in the specification including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. When a range of values is expressed, another embodiment includes from the one particular value and/or to the other particular value. Further, reference to values stated in ranges include each and every value within that range. All ranges are inclusive and combinable. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment.
- It is to be appreciated that certain features of the disclosed compositions, methods, and kits which are, for clarity, described herein in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the disclosed compositions, methods, and kits that are, for brevity, described in the context of a single embodiment, may also be provided separately or in any subcombination.
- The term “about” when used in reference to numerical ranges, cutoffs, or specific values is used to indicate that the recited values may vary by up to as much as 25% from the listed value. As many of the numerical values used herein are experimentally determined, it should be understood by those skilled in the art that such determinations can, and often times will, vary among different experiments. The values used herein should not be considered unduly limiting by virtue of this inherent variation. The term “about” is used to encompass variations of ±25% or less, variations of ±20% or less, variations of 10% or less, variations of ±5% or less, variations of ±1% or less, variations of ±0.5% or less, or variations of ±0.1% or less from the specified value.
- As used herein, “administering to said subject” and similar terms indicate a procedure by which the described anticonvulsant agents or compositions, together or separately, are introduced into, implanted in, injected into, or applied onto a subject such that target cells, tissues, or segments of the body of the subject are contacted with the agent.
- The terms “near” and “around” when used in reference to the site of administration of the described anticonvulsant agents or compositions should be understood by those skilled in the art to mean administered to the anatomical area of interest within the limits of traditionally practiced surgical and image-guided surgical procedures. For example, administration “near” the relevant anatomical site refers to a location that is not directly within or on the site, but sufficiently close to the site to provide a therapeutically relevant effect thereon. Those of ordinary skill in the art can readily determine the maximum distance from a given anatomical site that will be sufficient to provide a therapeutically relevant effect using a composition according to the present disclosure having a known concentration of active ingredient.
- For purposes of the present disclosure, a substance is “biodegradable” if it is capable of being at least partially broken down within and cleared by the human body over time by natural biological, biochemical, and/or physiological processes. For example, carriers comprising polyesters, such as, poly(lactide-co-glycosides) (PLGA), poly(lactides) (PLA), or copolymers of PLGA or PLA with poly(ethylene glycol) (PEG), which are broken down by the human body by hydrolytic and enzymatic cleavage, through interaction with water and esterases, respectively, are thus referred to as biodegradable carriers.
- “Pharmaceutically acceptable” refers to those properties and substances which are acceptable to the patient from a pharmacological/toxicological point of view and to the manufacturing pharmaceutical chemist from a physical/chemical point of view regarding composition, formulation, stability, patient acceptance, and bioavailability.
- “Pharmaceutically acceptable carrier” refers to a medium that does not interfere with the effectiveness of the biological activity of the active ingredient(s) and is not toxic to the host to which it is administered.
- “Therapeutically effective dose” refers to an amount of a composition, as described herein, effective to achieve a particular biological or therapeutic result such as, but not limited to, biological or therapeutic results disclosed, described, or exemplified herein. The therapeutically effective dose may vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the composition to cause a desired response in a subject. Such results may include, but are not limited to, the treatment of acute, post-operative or chronic pain, as determined by any means suitable in the art.
- The terms “treating” or “treatment” refer to any success or indicia of success in the attenuation or amelioration of an injury, pathology or condition, including any objective or subjective parameter such as abatement, remission, diminishing of symptoms or making the injury, pathology, or condition more tolerable to the patient, slowing in the rate of inflammation, making the final point of inflammation less debilitating, improving a subject's physical or mental well-being, or prolonging the length of survival. The treatment may be assessed by objective or subjective parameters; including the results of a physical examination, neurological examination, or psychiatric evaluations.
- As used herein, “exposed on the surface” means that at least a portion of the anticonvulsant agent is not covered or encased by the biodegradable carrier and is accessible from the exterior of the biodegradable carrier. The anticonvulsant agent exposed on the surface can be fully exposed, such that the entire agent is on the surface of the biodegradable carrier, or can be partially exposed, such that only a portion of the agent is on the surface of the biodegradable carrier. The anticonvulsant agent that is exposed on the surface of the biodegradable carrier can be bound to the surface of the biodegradable carrier through, for example, covalent or non-covalent bonds, or can be incorporated within the biodegradable carrier such that a portion of the agent is exposed on the surface.
- As used herein, “incorporated within” means that the anticonvulsant agent is at least partially covered by, contained within, encased in, or entrapped by the biodegradable carrier. In such circumstances, the anticonvulsant agent may or may not be exposed on the surface of the biodegradable carrier. Depending on the type of biodegradable carrier present in the composition, the anticonvulsant agent may be located in a void space, such as a core, of the biodegradable carrier or dispersed within the biodegradable carrier with the potential for being exposed on the surface, or any combination thereof. In some embodiments, the anticonvulsant agent can be dispersed or distributed within the biodegradable carrier, and not partially exposed on the surface of the biodegradable carrier. In other embodiments, the anticonvulsant agent can be partially exposed on the surface of the biodegradable carrier. In other embodiments, the anticonvulsant agent can be both dispersed or distributed within the biodegradable carrier and partially exposed on the surface of the biodegradable carrier. In yet other embodiments, the anticonvulsant agent can be located in a void space of the biodegradable carrier. In yet other embodiments, the anticonvulsant agent can be both located in a void space of the biodegradable carrier and exposed on the surface of the biodegradable carrier.
- Biodegradable, polymeric microparticles and nanoparticles represent an attractive means to achieve the desired local delivery of therapeutic agents, often by administration of a depot formulation. These particles can be fabricated by a variety of techniques to incorporate neurologically active therapeutic agents, including, anticonvulsants. The fabrication technique dictates the physical, chemical, and mechanical properties of the resulting particles. Thus, to achieve desired therapeutically efficacious concentrations and durations, the fabrication technique and polymer must be selected appropriately. For example, buoyant poly(D,L-lactide-co-glycolide) (PLGA) microspheres were created by oil-in-oil emulsification to encapsulate and deliver hydrophilic small-molecule agents (e.g., inosine) for intrathecal administration for the treatment of central nervous system disorders (WO 2004/047768).
- The formulation of anticonvulsants within different biodegradable implants or carriers has been examined for achieving sustained therapeutic efficacy in epilepsy [see. e.g., Halliday et al., Adv Drug Deliv Rev., 2012, 64(10):953-64]. To these ends, the anticonvulsant, carbamazepine, has been studied as a model drug for incorporation within these types of devices [Klose et al., Inter J Pharmaceutics., 2011, 404:75-82; Barakat et al., Drug Deliv., 2006, 13(1):9-18; Pepic et al., J Microencapsulation., 2013, 30(2):151-160]; however, in these reports, the fabrication technique, polymer, and size were not selected appropriately to yield a clinically relevant drug delivery system for the treatment of acute, post-operative, or chronic pain indications. For example, different water-in-oil-in-water (w/o/w) double emulsification techniques have been utilized to fabricate either large, highly porous [Klose et al., Inter J Pharmaceutics., 2011, 404:75-82] or large, solid matrix [Barakat et al., Drug Deliv., 2006, 13(1):9-18] biodegradable poly(D,L-lactide-co-glycolide) (PLGA) microparticles incorporating carbamazepine. In both reports, the large particle size is necessary to extend the release duration, however, these forms are impractical for clinical translation as an injectable. Additionally, the intentional high, micro-scale porosity of the microparticles fabricated by Klose et al., limits the ability for sustained, long-term release applications. Further, the carbamazepine within the solid matrix microparticles fabricated by Barakat et al., is predominantly distributed on or within close proximity to the microparticle surface. This predominantly surface-associated carbamazepine gives rise to the observed high initial burst release and inability to sustain the release of therapeutically relevant concentrations. Furthermore, Pepic et al., utilized an oil-in-water (o/w) single emulsification technique to fabricate large, porous poly(ε-caprolactone) (PCL) microspheres incorporating carbamazepine. In this report, the high hydrophobic character and crystallinity of the PCL causes extremely slow biodegradation that is too slow to be clinically relevant as a biodegradable carrier for therapeutic delivery in the treatment of acute, post-operative, or chronic pain indications. This slow biodegradation combined with the porosity inherent to the PCL polymer matrix causes the carbamazepine release mechanism to be solely diffusion-based, rather than biodegradation-based, necessitating large particle sizes to extend release. These large particle sizes reported are also impractical for clinical translation as an injectable. Further, the carbamazepine within the polymer matrix was observed to be predominantly distributed on or within close proximity to the microparticle surface. This predominantly surface-associated carbamazepine gives rise to the observed high initial burst release and inability to sustain the release of therapeutically relevant concentrations.
- The present disclosure provides compositions that are formulated specifically to enable 1) control of anticonvulsant agent incorporation, including substantially even distribution throughout the polymer matrix, 2) control over anticonvulsant agent release rate, 3) clinically relevant biodegradation rates, and 4) control over the duration of anticonvulsant agent release at therapeutically efficacious concentrations, including sustained efficacious release for an extended period of time, such as one day or more, from nanoparticles, microparticles, or any combination thereof. Also described herein are methods for using these specifically designed compositions for the treatment of acute, post-operative, or chronic pain.
- Further, the present disclosure provides compositions that are formulated specifically to enable control over hydrodynamic diameter. The hydrodynamic diameter of the biodegradable carrier represents an important characteristic which influences 1) anticonvulsant incorporation, 2) anticonvulsant release rate, 3) biodegradation and clearance rate, 4) administration site residence duration, and 5) the ability to enable clinical administration of the composition as an injectable without necessitating a change to the standard of care.
- Disclosed herein are compositions for treating acute, post-operative, or chronic pain in a subject. In some embodiments, the compositions comprise an anticonvulsant agent and a biodegradable carrier. In some embodiments, the compositions consist of an anticonvulsant agent and a biodegradable carrier. In yet other embodiments, the compositions consist essentially of an anticonvulsant agent and a biodegradable carrier.
- Suitable biodegradable carriers include, but are not limited to, a nanoparticle, a microparticle, or any combination thereof. In some embodiments, the biodegradable carrier is a nanoparticle. In some embodiments, the biodegradable carrier is a microparticle. In some embodiments, the biodegradable carrier is a nanoparticle. In some embodiments, the biodegradable carrier is a nanoparticle.
- Suitable classes of nanoparticles or microparticles include, but are not limited to, polymeric. Further, said nanoparticles or microparticles may be solid, hollow, or a mixture thereof. Further, said nanoparticles or microparticles may be porous, wherein the porosity is defined solely by the density and packing arrangement of the polymer matrix and the incorporated anticonvulsant agent.
- Polymeric nanoparticles can have a mean hydrodynamic diameter up to 1 micron, as measured by dynamic light scattering in aqueous solution, wherein the hydrodynamic diameter is derived solely from the fabrication process in the absence of sieving the lyophilized product. Suitable instrumentation for aqueous solution phase dynamic light scattering includes the Malvern Instruments™ ZetaSizer® Nano ZS, wherein the mean is derived from the intensity distribution obtained with cumulants analysis. Polymeric microparticles can have a median and/or mean hydrodynamic diameter greater than or equal to 1 micron and up to about 25 microns, inclusive, as measured by laser diffraction in aqueous solution, wherein the hydrodynamic diameter is derived solely from the fabrication process in the absence of sieving the lyophilized product. Suitable instrumentation for aqueous solution phase laser diffraction includes the Malvern Instruments™ Mastersizer® 3000 equipped with the Hydro MV unit, where median and mean hydrodynamic diameter are calculated as d[50] and d[3.2], respectively. For example, microparticles can be fabricated via solvent extraction/evaporation, single oil-in-water emulsification to have a median hydrodynamic diameter (d[50]) of 18 microns, as measured by laser diffraction in aqueous solution, by precisely controlling the shear-rate and viscosity of the emulsion. Further, the disclosed compositions have sufficiently small median and/or mean hydrodynamic diameters up to 25 microns, inclusive, to enable clinical administration as an injectable without changing the standard of care.
- Suitable anticonvulsant agents include, but are not limited to, carbamazepine, pregabalin, phenytoin, gabapentin, topiramate, oxcarbazepine, or any combination thereof. In some embodiments, the anticonvulsant agent is carbamazepine. In some embodiments, the anticonvulsant agent is phenytoin. In some embodiments, the anticonvulsant agent is gabapentin. In some embodiments, the anticonvulsant agent is pregabalin.
- The disclosed compositions can comprise, consist of, or consist essentially of an anticonvulsant agent and a biodegradable carrier. In some embodiments, the composition comprises, consists of, or consists essentially of carbamazepine and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of carbamazepine and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of phenytoin and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of phenytoin and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of gabapentin and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of gabapentin and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of pregabalin and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of pregabalin and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of topiramate and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of topiramate and a microparticle. In some embodiments, the composition comprises, consists of, or consists essentially of oxcarbazepine and a nanoparticle. In some embodiments, the composition comprises, consists of, or consists essentially of oxcarbazepine and a microparticle.
- Anticonvulsant agents also include mixtures of carbamazepine, pregabalin, phenytoin, gabapentin, topiramate, and/or oxcarbazepine within the same biodegradable carrier. For example, and without intent to be limiting, in some aspects the composition can comprise carbamazepine and pregabalin within a microparticle.
- In some embodiments, the anticonvulsant agent can be formulated to comprise up to 1% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 5% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 10% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 15% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 20% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 25% by weight, inclusive, of the biodegradable carrier. In some embodiments, the anticonvulsant agent can be formulated to comprise up to 50% by weight, inclusive, of the biodegradable carrier.
- Throughout the present disclosure, the phrase “the anticonvulsant agent” can refer to more than one anticonvulsant agent if more than one such agent is present in the composition. For example, when only one anticonvulsant agent is contained within the biodegradable carrier, a reference to release of “60% of the anticonvulsant agent” means that there is release of 60% of the sole present anticonvulsant. When more than one anticonvulsant agent is contained within the biodegradable carrier, language referring to release of “60% of the anticonvulsant agent”, means that 60% of the total complement of anticonvulsant agents is released. Thus, if the composition includes 3 mg of a first anticonvulsant agent and 3 mg of a second anticonvulsant agent, then release of “60% of the anticonvulsant agent” can mean that 60% of the total complement of 6 mg of anticonvulsant agents is released.
- Biodegradable carriers can comprise, consist of, or consist essentially of a number of materials suitable for delivering an anticonvulsant agent to a subject, including synthetically derived, biodegradable polymers. Exemplary polymers include, but are not limited to, poly(lactides) (PLA), poly(glycolides) (PGA), poly(lactide-co-glycolides) (PLGA), or copolymers of said polymers with poly(ethylene glycol)(PEG), or any combination thereof. In some embodiments, the biodegradable carrier comprises, consists of, or consists essentially of a synthetically derived biodegradable polymer. Additionally, in some embodiments, the synthetically derived biodegradable polymer can be poly(lactic-co-glycolic acid) (PLGA), having a lactic acid and glycolic acid content ranging from 0-100% for each monomer. For example, in some aspects, the biodegradable polymer can be a 50:50 PLGA, where 50:50 refers to the ratio of lactic to glycolic acid. In some embodiments, the biodegradable carrier comprises, consists of, or consists essentially of a copolymer. For example, in some embodiments, the biodegradable polymer can be a copolymer of poly(ethylene glycol) (PEG) and poly(lactic-co-glycolic acid) (PLGA), having a lactic acid and glycolic acid content ranging from 0-100% for each monomer.
- Biodegradable carriers can be configured to be injected into a subject. For example, in some aspects, the biodegradable carrier comprises a nanoparticle that is configured to be injected into a subject. In other aspects, the biodegradable carrier comprises a microparticle that is configured to be injected into a subject. For injection into a subject, the microparticle must have a median and/or mean hydrodynamic diameter of not more than 25 microns, inclusive, as measured by the aforementioned aqueous solution phase laser diffraction instrumentation.
- Biodegradable carriers can also be configured to be implanted into a subject. Implants can be any size and shape suitable for delivering an anticonvulsant to or near the site of pain.
- Biodegradable carriers can further comprise one or more surface modifications. Examples of suitable surface modification include, but are not limited to, functional group modifications, PEGylation or affinity-based targeting moieties. In some embodiments, the biodegradable carrier can be PEGylated. Surface modifications can prevent the carrier from migrating from the site of administration, abrogate the foreign body response, and/or minimize clearance by immune system cells.
- The anticonvulsant agent can be exposed on the surface of the biodegradable carrier, incorporated within the biodegradable carrier, or both. In some embodiments, the anticonvulsant agent is incorporated within the biodegradable carrier.
- When the anticonvulsant agent is incorporated within the biodegradable carrier, the process of incorporation may be accomplished using solvent extraction/evaporation, oil-in-water (o/w) single emulsification in the presence of a stabilizing surfactant. Suitable surfactants for stabilizing this oil-in-water emulsion include, but are not limited to, poly(vinyl alcohol) (PVA),
polysorbate 80, polysorbate 85, poly(ethylene glycol), or any combination thereof. - When the anticonvulsant agent is incorporated within the biodegradable carrier, exemplary polymers for forming the biodegradable carrier include, but are not limited to, PLGA, PLA, PLGA-PEG and PLA-PEG block copolymers, or any combination thereof.
- The biodegradable carrier for use in an incorporated system can be chosen to begin to degrade within any suitable time frame following preparation for administration of the composition to a subject. In some embodiments, the biodegradable carrier can begin to degrade upon resuspension in aqueous media. In some embodiments, the biodegradable carrier can begin to degrade upon administration of the composition to a subject.
- Degradation, diffusion, or any combination thereof, can lead to the controlled release of the anticonvulsant agent from the biodegradable carrier. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 3 hours. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 6 hours. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 12 hours. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 1 day. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 2 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 3 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 4 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 5 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 6 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 7 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 8 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 9 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 10 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 12 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 14 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 18 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 21 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 28 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 35 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 42 days. In some embodiments, the biodegradable carrier releases less than 60%/o of the anticonvulsant agent over about 56 days. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 3 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 4 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 5 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 6 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 7 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 8 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 9 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 10 months. In some embodiments, the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 12 months.
- Degradation of the biodegradable carrier can lead to the controlled release of and/or delivery of the anticonvulsant agent, thus providing a therapeutically effective dose of the agent to the subject. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 hours. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 6 hours. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 12 hours. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 1 day. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 2 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 4 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 5 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 6 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 7 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 8 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 9 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 10 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 12 days. In some embodiments, the biodegradable carrier provides a therapeutically effect dose of the agent for up to 14 days. In some embodiments, the biodegradable carrier provides a therapeutically effect dose of the agent for up to 18 days. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 weeks. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 1 month. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 2 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 3 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 4 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 5 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 6 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 7 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 8 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 9 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 10 months. In some embodiments, the biodegradable carrier provides a therapeutically effective dose of the agent for up to 12 months.
- Degradation of the biodegradable carrier can lead to the controlled release of and/or delivery of the anticonvulsant agent, providing a therapeutically effective dose of the agent to the subject, while maintaining systemic blood plasma concentrations of the anticonvulsant agent that are lower than those associated with oral dosing or administration. In some embodiments, the blood plasma concentration of the anticonvulsant agent can be 1/1000 or less than the blood plasma concentration associated with oral dosing or administration. In some embodiments, the blood plasma concentration of the anticonvulsant agent can be 1/500 or less than the blood plasma concentration associated with oral dosing or administration. In some embodiments, the blood plasma concentration of the anticonvulsant agent can be 1/100 or less than the blood plasma concentration associated with oral dosing or administration. In other embodiments, the blood plasma concentration of the anticonvulsant agent can be below detection limits of analytical measurements.
- Pharmaceutical agents may also be included in the compositions described herein. In some aspects, the pharmaceutical agents may stabilize the composition, allow it to be readily administered to a subject, increase its ability to treat acute, chronic, or post-operative pain, or otherwise make the composition suitable for therapeutic use in a subject. Accordingly, the described composition may further comprise a pharmaceutically acceptable carrier or excipient, as would be known to an individual skilled in the relevant art. In view of the inclusion of pharmaceutical agents in some of the described compositions, disclosed herein are also pharmaceutical compositions having an anticonvulsant and a biodegradable carrier, as provided herein. The described pharmaceutical compositions for delivery or injection of the described compositions may be administered to a subject in order to maintain the ability to treat chronic pain in the subject over a prolonged period of time. For example, composition viscosity and concentration of the agent may be altered to increase the half-life of composition's active ingredients.
- The described pharmaceutical compositions may be formulated as any of various preparations that are known and suitable in the art, including those described and exemplified herein. In some embodiments, the pharmaceutical compositions are aqueous formulations. Aqueous solutions may be prepared by admixing the described compositions in water or suitable physiologic buffer, and optionally adding suitable colorants, preservatives, stabilizing and thickening agents, ions such as calcium or magnesium, and the like as desired. Aqueous suspensions may also be made by dispersing the described compositions in water or physiologic buffer with viscous material, such as natural or synthetic gums, resins, methylcellulose, sodium carboxymethylcellulose, and other well-known suspending agents.
- When the present compositions are prepared as aqueous suspensions, the suspensions may be formulated by dispersing the present biodegradable carrier and active agent within injectable, in situ cross-linking hydrogel solution precursors, including, but not limited to, naturally derived polymers (e.g. polysaccharides) and/or synthetically derived polymers (e.g. PEG, PGA-PEG-PGA. PLA-PEG-PLA, PLGA-PEG-PLGA). The resulting compositions may then be administered to a subject, for example, by injection. Accordingly, a hydrogel may function as an excipient in which the biodegradable carrier and active agent are dispersed.
- The present compositions may also be prepared as liquid formulations and solid form preparations which are intended to be converted, shortly before use, to liquid preparations. Such liquids include solutions, suspensions, syrups, slurries, and emulsions. Liquid preparations may be prepared by conventional means with pharmaceutically acceptable additives such as suspending agents (e.g., sorbitol syrup, cellulose derivatives or hydrogenated edible fats or oils); emulsifying agents (e.g., lecithin or acacia); non-aqueous vehicles (e.g., almond oil, oily esters, or fractionated vegetable oils); and preservatives (e.g., methyl or propyl-p-hydroxybenzoates or sorbic acid). These preparations may contain, in addition to the active agent, stabilizers, buffers, dispersants, thickeners, solubilizing agents, and the like. The compositions may be in powder or lyophilized form for constitution with a suitable vehicle such as sterile water, physiological buffer, saline solution, or alcohol, before use. The compositions may be formulated for injection into a subject. For injection, the compositions described may be formulated in aqueous solutions such as water or alcohol, or in physiologically compatible buffers such as Hanks's solution. Ringer's solution, or physiological saline buffer. The solution may contain one or more formulatory agents such as suspending, stabilizing or dispersing agents. Injection formulations may also be prepared as solid form preparations which are intended to be converted, shortly before use, to liquid form preparations suitable for injection, for example, by constitution with a suitable vehicle, such as sterile water, saline solution, or alcohol before use.
- Also provided herein are methods of treating a subject having acute, post-operative, or chronic pain comprising administering to a subject having acute, post-operative, or chronic pain any one of the compositions disclosed herein. In some embodiments, the methods of treating a subject having acute, post-operative, or chronic pain can comprise administering to a subject having the pain a composition comprising an anticonvulsant agent and a biodegradable carrier. In other embodiments, the methods of treating a subject having acute, post-operative, or chronic pain can comprise administering to a subject having the pain a composition consisting of an anticonvulsant agent and a biodegradable carrier. In yet other embodiments, the methods of treating a subject having acute, post-operative, or chronic pain can comprise administering to a subject having the pain a composition consisting essentially of an anticonvulsant agent and a biodegradable carrier.
- The disclosed compositions can be administered by injection or implantation. For example, the composition can be injected or surgically placed on or near the nerve of interest. Local delivery allows a therapeutic concentration of the composition to be delivered to the nerve in question, without the systemic levels, including, but not limited to, blood plasma concentrations, rising as high as when oral or systemic delivery is used for the same effect. Consequently, the systemic side effects can be greatly reduced or entirely eliminated.
- The compositions can be injected by a number of routes, including, but not limited to, epidurally, intravenously, intra-arterially, transdermally, subcutaneously, intra-articularly, intramuscularly, perineurally, percutaneously, or any combination thereof. Alternatively, the compositions can be implanted at or near a site of acute, post-operative, or chronic pain.
- In some embodiments, the composition can be administered near or onto a sensory neuron. For example, in some aspects, the composition can be injected near or onto a sensory neuron. In other aspects, the composition can be surgically implanted near or onto a sensory neuron. In other embodiments, the composition can be administered near or onto a synapse. In some aspects, the composition can be injected near or onto a synapse. In other aspects, the composition can be surgically implanted near or onto a synapse. In yet other embodiments, the composition can be administered near or onto a dorsal root ganglion. In some aspects, the composition can be injected near or onto a dorsal root ganglion. In other aspects, the composition can be surgically implanted near or onto a dorsal root ganglion. In yet other embodiments, the composition can be administered near or onto sensory nerve. In some aspects, the composition can be injected near or onto a sensory nerve. In other aspects, the composition can be surgically implanted near or onto a sensory nerve. In yet other embodiments, the composition can be administered near or onto a peripheral nerve. In some aspects, the composition can be injected near or onto a peripheral nerve. In other aspects, the composition can be surgically implanted near or onto a peripheral nerve. In yet other embodiments, the composition can be administered near or onto a medial nerve branch. In some aspects, the composition can be injected near or onto a medial nerve branch. In other aspects, the composition can be surgically implanted near or onto a medial nerve branch. In yet other embodiments, the composition can be administered into or around intramuscular tissue. In some aspects, the composition can be injected into or around intramuscular tissue. In other aspects, the composition can be surgically implanted into or around intramuscular tissue. In yet other embodiments, the composition can be administered into or around an intra-articular joint. In some aspects, the composition can be injected into or around an intra-articular joint. In other aspects, the composition can be surgically implanted into or around an intra-articular joint. In yet other embodiments, the composition can be administered into or around a facet joint. In some aspects, the composition can be injected into or around a facet joint. In other aspects, the composition can be surgically implanted into or around a facet joint. In yet other embodiments, the composition can be administered near or onto the femoral nerve. In some aspects, the composition can be injected near or onto the femoral nerve. In other aspects, the composition can be surgically implanted near or onto the femoral nerve. In yet other embodiments, the composition can be administered near or onto the sciatic nerve. In some aspects, the composition can be injected near or onto the sciatic nerve. In other aspects, the composition can be surgically implanted near or onto the sciatic nerve. In yet other embodiments, the composition can be administered near or onto the brachial plexus. In some aspects, the composition can be injected near or onto the brachial plexus. In other aspects, the composition can be surgically implanted near or onto the brachial plexus. In yet other embodiments, the composition can be administered near or onto the lumbar plexus. In some aspects, the composition can be injected near or onto the lumbar plexus. In other aspects, the composition can be surgically implanted near or onto the lumbar plexus. In yet other embodiments, the composition can be administered into or around the epidural space. In some aspects, the composition can be injected into or around the epidural space. In other aspects, the composition can be surgically implanted into or around the epidural space. In yet other embodiments, the composition can be administered near or onto the inferior alveolar nerve. In some aspects, the composition can be injected near or onto the inferior alveolar nerve. In other aspects, the composition can be surgically implanted near or onto the inferior alveolar nerve. In yet other embodiments, the composition can be administered near or onto the trigeminal nerve. In some aspects, the composition can be injected near or onto the trigeminal nerve. In other aspects, the composition can be surgically implanted near or onto the trigeminal nerve.
- The disclosed methods can be used to treat acute, post-operative, or chronic pain caused by a number of ailments, diseases, and/or injuries including, but not limited to pain caused by trauma, post-operative pain, dental pain, degenerative disk disease, spinal stenosis, spinal disc herniation, radiculopathy, radiculitis, arachnoiditis, trigeminal neuralgia, postherpetic neuralgia, shingles, occipital neuralgia, cervicogenic headache, migraine headaches, cluster headaches, back pain, facet joint pain, intra-articular joint pain, intramuscular pain, complex regional pain syndrome, cancer associated pain, neuropathy, diabetic neuropathic pain, tabetic neuralgia, sciatic neuralgia, sciatica, or any combination thereof.
- The disclosed compositions can be used to treat acute or chronic pain associated with back pain or facet joint pain by, for example, administering the composition on or near the nerve root or the medial branch nerves near the source of the pain.
- The disclosed compositions can be used to treat chronic pain associated with cervicogenic headache, migraine headaches, and cluster headaches by, for example, administering the composition onto or near the greater occipital nerve.
- The disclosed compositions can be used to treat chronic pain associated with trigeminal neuralgia and the trigeminal nerve by, for example, administering the composition onto or near the Gasserian ganglion or into Meckel's Cave.
- The disclosed compositions can be used to treat chronic pain associated with postherpetic neuralgia by, for example, administering the composition onto or near the nerve root, the dorsal nerve root ganglion, or distal to the dorsal nerve root ganglion.
- The disclosed compositions can be used to treat acute or chronic pain associated with sciatic neuralgia and the sciatic nerve by, for example, administering the composition onto or near the sciatic nerve.
- The disclosed compositions can be used to treat acute or post-operative pain associated with knee surgery or knee-replacement surgery by, for example, administering the composition onto or near the femoral nerve.
- The disclosed compositions can be used to treat acute or post-operative pain associated with hip surgery or hip-replacement surgery by, for example, administering the composition onto or near the femoral and/or sciatic nerve.
- The disclosed compositions can be used to treat acute or post-operative pain associated with hip surgery or hip-replacement surgery by, for example, administering the composition onto or near the lumbar plexus.
- The disclosed compositions can be used to treat acute or post-operative pain associated with shoulder surgery by, for example, administering the composition onto or near the brachial plexus.
- The disclosed compositions can be used to treat acute or post-operative pain associated with dental procedures or surgery by, for example, administering the composition onto or near the inferior alveolar nerve or trigeminal nerve.
- Any chronic, acute, or post-operative pain that can be temporarily relieved by a local anesthetic nerve block or corticosteroid injection can potentially be treated long term by delivering the disclosed compositions to the same location that the local anesthetic is applied.
- The disclosed compositions can be used to treat acute, post-operative, or chronic pain that can be relieved by a sensory and/or peripheral nerve block.
- Also provided herein are kits for producing a composition to treat acute, post-operative, or chronic pain in a subject; the kit comprising, consisting of, or consisting essentially of an anticonvulsant agent, a biodegradable carrier, and instructions for producing the composition. The instructions may describe the steps and reagents for producing the composition by solvent extraction/evaporation, oil-in-water single emulsification, by spray drying, or by precipitation using a solvent/non-solvent system. Such steps and reagents may be in accordance with those that the present application discloses for solvent extraction/evaporation, oil-in-water single emulsification, spray drying, and precipitation using a solvent/non-solvent system.
- Biodegradable, polymeric microparticles were fabricated using a solvent extraction/evaporation, single oil-in-water (o/w) emulsification method. PLGA (0-20 wt %) and carbamazepine (0-20 wt %) were dissolved in a suitable, volatile organic solvent (e.g. dichloromethane, ethyl acetate). The resulting polymer solution dispersant phase was added to an aqueous continuous phase containing 1-5% (w/v) of surfactant (PVA) under constant shear rate mixing to create a single o/w microemulsion. The resulting stable microemulsion was subsequently added to an evaporation bath containing 100 mL of deionized water containing a trace concentration (0-0.5% (w/v)) of surfactant (PVA) under stirring at 350 rpm for 3 hours to effectively extract and evaporate the organic solvent. The hardened microparticles were then collected, purified with deionized water, and lyophilized.
- Evaluation of Efficacy with 1% Carbamazepine-Loaded Microparticles.
- Mechanical allodynia was measured to determine therapeutic efficacy using a pressure transducer [electronic von Frey anaesthesiometer, IITC-Life Sciences] with a 800 gram rigid probe. Animals were placed in a test cage with a wire mesh floor and allowed to acclimate for 10 minutes. The tip of the rigid probe was then applied to the middle of the plantar surface both the surgically ligated and the normal hindpaw. Withdrawal threshold was measured in triplicate and the average of the measurements was expressed as a pain tolerance level in grams. Baseline measurements of mechanical allodynia were recorded for all rats prior to the establishment of the chronic constriction injury (CCI) surgical rodent model. To establish the CCI model, the surgical method described by Bennett et al. was generally followed. Rats (Sprague Dawley, male, 6-7 weeks of age, 200 g, n=250) were anaesthetized with isofluorane. The left common sciatic nerve was exposed by surgical dissection through the biceps femoris. Proximal to the trifurcation of the sciatic nerve, 8 mm of the nerve was detached from connective tissue. Three ligatures (sterile, braided silk suture thread) were tied loosely around the nerve at 1 mm spacings, thus affecting 4-6 mm of the nerve. Great care was taken to reproducibly tie the ligatures such that slight constriction of the nerve was achieved when viewed with 40× magnification. Following ligation, the surgical incision was closed. Pain was allowed to progressively develop over the subsequent 72 hours. At 72 hours post-ligation surgery, baseline measurements mechanical allodynia were recorded within 2 hours prior to therapeutic administration to ascertain behavioral pathology. For all control and treatment groups, administration of the dose was performed by direct injection through the biceps femoris within close proximity to the ligated sciatic nerve. To establish negative control groups, sterile injections of 0.9% saline (150 μL, n=6) and unloaded microparticles (suspension, 20 μm, 20 mg, 150 μL, n=12) were performed. To establish a positive control group, sterile injections of soluble carbamazepine (100 μg/mL, 150 μL, n=12) were performed. For treatment groups, sterile injections of Exparel™ (150 μL, n=12) or carbamazepine-loaded microparticles (suspension, 20 μm, 20 mg microparticles, 200 μg encapsulated carbamazepine, 150 μL, n=12) were performed. At specified times post-injection (3 hours, 5 hours, and 1, 2, 3, 4, 7, 10, 14, 18, and 21 days), double-blinded measurements of mechanical allodynia were recorded for subsequent analysis.
- Analysis of the Pharmacokinetics of Released Carbamazepine.
- Rats (Sprague Dawley, male, 6-7 weeks of age, 200 g, n=5 per time point) were anaesthetized with isofluorane. The left common sciatic nerve was minimally exposed by surgical dissection through the biceps femoris. Sterile injections of carbamazepine-loaded microparticles (suspension, 20 μm, 20 mg microparticles, 200 μg encapsulated carbamazepine, 150 μL, n=5 per time point) were administered by direct injection through the biceps femoris within close proximity to the sciatic nerve. At specified times post-injection (3 hours, 24 hours, and 3, 7, 10, 14, 21, 28, and 42 days), 8 mL of whole blood were collected in heparinized tubes prior to euthanasia. The blood plasma was separated by centrifugation. Carbamazepine was then extracted and concentrated by solid phase extraction for subsequent analysis by RP-UPLC.
- Those skilled in the art will appreciate that numerous changes and modifications can be made to the preferred embodiments of the invention and that such changes and modifications can be made without departing from the spirit of the invention. It is, therefore, intended that the appended claims cover all such equivalent variations as fall within the true spirit and scope of the invention.
Claims (64)
1. A composition for treating acute, post-operative, or chronic pain in a subject comprising:
an anticonvulsant agent in the absence of a local anesthetic; and
a carrier comprising poly(lactide-co-glycolides), poly(lactides), copolymers of these said polymers with poly(ethylene glycol), or any combination thereof,
wherein the anticonvulsant agent is incorporated within the biodegradable carrier by solvent extraction/evaporation, oil-in-water single emulsification, by spray drying, or by precipitation using a solvent/non-solvent system.
2. The composition of claim 1 , wherein the anticonvulsant agent comprises carbamazepine, pregabalin, phenytoin, gabapentin, topiramate, or oxcarbazepine, or any combination thereof.
3. The composition of claim 1 , wherein the anticonvulsant agent is carbamazepine.
4. The composition of claim 1 , wherein the anticonvulsant agent is gabapentin.
5. The composition of claim 1 , wherein the anticonvulsant agent is pregabalin.
6. The composition of claim 1 , wherein the anticonvulsant agent is phenytoin.
7. The composition of claim 1 , wherein the anticonvulsant agent is exposed on the surface of the carrier, incorporated within the carrier, or both.
8. The composition of claim 1 , wherein the carrier comprises a microparticle, a nanoparticle, or any combination thereof.
9. The composition of claim 8 , wherein the microparticle has a median hydrodynamic diameter of greater than or equal to 1 micron and up to 25 microns, inclusive, as measured by aqueous solution phase laser diffraction instrumentation.
10. The composition of claim 8 , wherein the microparticle has a mean hydrodynamic diameter of greater than or equal to 1 micron and up to 25 microns, inclusive, as measured by aqueous solution phase laser diffraction instrumentation.
11. The composition of claim 8 , wherein the nanoparticle has a mean hydrodynamic diameter of up to 1 micron, as measured by aqueous solution phase dynamic light scattering instrumentation.
12. The composition of claim 8 , wherein the hydrodynamic diameter of the carrier is derived solely from the fabrication process in the absence of sieving the lyophilized product.
13. The composition of claim 1 , wherein the carrier degrades following administration to said subject, resulting in the release of the anticonvulsant agent.
14. The composition of claim 1 , wherein the anticonvulsant agent comprises up to 50% by weight, inclusive, of the carrier.
15. The composition of claim 1 , wherein the carrier releases less than 60% of the anticonvulsant agent over about 3 hours, 6 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 12 days, 14 days, 16 days, 18 days, 21 days, 28 days, 35 days, 42 days, 49 days, 56 days, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, or 12 months.
16. The composition of claim 1 , wherein the carrier provides a therapeutically effective dose of the anticonvulsant agent for up to 3 hours, 6 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 12 days, 14 days, 18 days, 3 weeks, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, or 12 months, inclusive.
17. The composition of claim 16 , wherein the carrier provides a therapeutically effective dose of the anticonvulsant agent, while maintaining systemic blood plasma concentrations of the anticonvulsant agent that are lower than those associated with oral dosing or administration.
18. The composition of claim 1 , further comprising a pharmaceutically acceptable carrier or excipient.
19. A method of treating a subject having acute, post-operative, or chronic pain comprising administering to said subject a composition comprising:
an anticonvulsant agent in the absence of a local anesthetic; and
a biodegradable carrier.
20. The method of claim 19 , wherein the biodegradable carrier comprises poly(lactide-co-glycolides), poly(lactides), copolymers of these said polymers with poly(ethylene glycol), or any combination thereof; and,
wherein the anticonvulsant agent is incorporated within the biodegradable carrier by solvent extraction/evaporation, oil-in-water single emulsification, by spray drying, or by precipitation using a solvent/non-solvent system.
21. The method of claim 19 , wherein the composition is administered into and/or around the epidural space in said subject.
22. The method of claim 19 , wherein the composition is administered into and/or around an intra-articular joint of said subject.
23. The method of claim 19 , wherein the composition is administered into and/or around a facet joint of said subject.
24. The method of claim 19 , wherein the compositions is administered into and/or around intramuscular tissue in said subject.
25. The method of claim 19 , wherein the composition is administered onto or near a sensory nerve of said subject.
26. The method of claim 25 , wherein the sensory nerve is the femoral nerve.
27. The method of claim 25 , wherein the sensory nerve is the sciatic nerve.
28. The method of claim 25 , wherein the sensory nerve is the brachial plexus.
29. The method of claim 25 , wherein the sensory nerve is the lumbar plexus.
30. The method of claim 25 , wherein the sensory nerve is the inferior alveolar nerve.
31. The method of claim 25 , wherein the sensory nerve is the trigeminal nerve.
32. The method of claim 19 , wherein the composition is administered onto or near a peripheral nerve of said subject.
33. The method of claim 32 , wherein the peripheral nerve is the femoral nerve.
34. The method of claim 32 , wherein the peripheral nerve is the sciatic nerve.
35. The method of claim 32 , wherein the peripheral nerve is the brachial plexus.
36. The method of claim 32 , wherein the peripheral nerve is the lumbar plexus.
37. The method of claim 32 , wherein the peripheral nerve is the inferior alveolar nerve.
38. The method of claim 32 , wherein the peripheral nerve is the trigeminal nerve.
39. The method of claim 19 , wherein the composition is administered onto or near a dorsal root ganglion of said subject.
40. The method of claim 19 , wherein the composition is administered onto or near a medial nerve branch of said subject.
41. The method of claim 19 , wherein the composition is injected or surgically implanted in said subject.
42. The method of claim 19 wherein the acute, post-operative, or chronic pain is caused by trauma, post-operative pain, dental pain, degenerative disk disease, spinal stenosis, spinal disc herniation, radiculopathy, radiculitis, arachnoiditis, trigeminal neuralgia, postherpetic neuralgia, shingles, occipital neuralgia, cervicogenic headache, migraine headaches, cluster headaches, back pain, facet pain, intra-articular joint pain, intramuscular pain, complex regional pain syndrome, cancer associated pain, neuropathy, diabetic neuropathic pain, tabetic neuralgia, sciatic neuralgia, sciatica, or any combination thereof.
43. The method according to claim 19 , wherein the anticonvulsant agent comprises carbamazepine, pregabalin, phenytoin, gabapentin, topiramate, or oxcarbazepine, or any combination thereof.
44. The method according to claim 43 , wherein the anticonvulsant agent is carbamazepine.
45. The method according to claim 43 , wherein the anticonvulsant agent is gabapentin.
46. The method according to claim 43 , wherein the anticonvulsant agent is pregabalin.
47. The method according to claim 43 , wherein the anticonvulsant agent is phenytoin.
48. The method according to claim 19 , wherein the anticonvulsant agent is exposed on the surface of the biodegradable carrier, incorporated within the biodegradable carrier, or both.
49. The method according to claim 19 , wherein the biodegradable carrier comprises a microparticle, a nanoparticle, or any combination thereof.
50. The method according to claim 49 , wherein the microparticle, nanoparticle, or any combination thereof, comprises poly(lactide), poly(lactide-co-glycolide), a copolymer of poly(lactide) and poly(ethylene glycol), or a copolymer of poly(lactide-co-glycolide) and poly(ethylene glycol), or any combination thereof.
51. The method according to claim 49 , wherein the microparticle has a median hydrodynamic diameter of greater than or equal to 1 micron and up to 25 microns, inclusive, as measured by aqueous solution phase laser diffraction instrumentation.
52. The method according to claim 49 , wherein the microparticle has a mean hydrodynamic diameter of greater than or equal to 1 micron and up to 25 microns, inclusive, as measured by aqueous solution phase laser diffraction instrumentation.
53. The method according to claim 49 , wherein the nanoparticle has a mean hydrodynamic diameter of up to 1 micron, as measured by aqueous solution phase dynamic light scattering instrumentation.
54. The method according to claim 49 , wherein the hydrodynamic diameter of the biodegradable carrier is derived solely from the fabrication process in the absence of sieving the lyophilized product.
55. The method according to claim 19 , wherein the biodegradable carrier degrades following being administered to the subject, resulting in the release of the anticonvulsant agent.
56. The method according to claim 19 , wherein the anticonvulsant agent comprises up to 50% by weight, inclusive, of the biodegradable carrier.
57. The method according to claim 19 , wherein the biodegradable carrier releases less than 60% of the anticonvulsant agent over about 3 hours, 6 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 12 days, 14 days, 16 days, 18 days, 21 days, 28 days, 35 days, 42 days, 49 days, 56 days, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, or 12 months.
58. The method according to claim 19 , wherein the biodegradable carrier provides a therapeutically effective dose of the anticonvulsant agent for up to 3 hours, 6 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 12 days, 14 days, 18 days, 3 weeks, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, or 12 months, inclusive.
59. The method according to claim 58 , wherein the biodegradable carrier provides a therapeutically effective dose of the anticonvulsant agent, while maintaining systemic blood plasma concentrations of the anticonvulsant agent that are lower than those associated with oral dosing or administration.
60. The method according to claim 19 , further comprising a pharmaceutically acceptable carrier or excipient.
61. A kit for producing the composition of claim 1 , the kit comprising:
an anticonvulsant agent in the absence of a local anesthetic;
a carrier comprising poly(lactide-co-glycolides), poly(lactides), copolymers of these said polymers with poly(ethylene glycol), or any combination thereof; and
instructions for producing said composition.
62. The kit according to claim 61 wherein said instructions are for incorporating the anticonvulsant agent within the carrier by solvent extraction/evaporation, oil-in-water single emulsification.
63. The kit according to claim 61 wherein said instructions are for incorporating the anticonvulsant agent within the carrier by spray drying.
64. The kit according to claim 61 wherein said instructions are for incorporating the anticonvulsant agent within the carrier by precipitation using a solvent/non-solvent system.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/938,274 US20160136094A1 (en) | 2014-11-18 | 2015-11-11 | Compositions For Treating Acute, Post-Operative, or Chronic Pain and Methods of Using the Same |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201462081162P | 2014-11-18 | 2014-11-18 | |
US14/628,563 US20160136179A1 (en) | 2014-11-18 | 2015-02-23 | Compositions For Treating Acute, Post-Operative, Or Chronic Pain and Methods of Using the Same |
US14/938,274 US20160136094A1 (en) | 2014-11-18 | 2015-11-11 | Compositions For Treating Acute, Post-Operative, or Chronic Pain and Methods of Using the Same |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/628,563 Continuation-In-Part US20160136179A1 (en) | 2014-11-18 | 2015-02-23 | Compositions For Treating Acute, Post-Operative, Or Chronic Pain and Methods of Using the Same |
Publications (1)
Publication Number | Publication Date |
---|---|
US20160136094A1 true US20160136094A1 (en) | 2016-05-19 |
Family
ID=55960725
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/938,274 Abandoned US20160136094A1 (en) | 2014-11-18 | 2015-11-11 | Compositions For Treating Acute, Post-Operative, or Chronic Pain and Methods of Using the Same |
Country Status (1)
Country | Link |
---|---|
US (1) | US20160136094A1 (en) |
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20170239183A1 (en) * | 2016-02-23 | 2017-08-24 | PixarBio Corporation | COMPOSITIONS COMPRISING NAv1.7 SELECTIVE INHIBITORS FOR TREATING ACUTE, POST-OPERATIVE, OR CHRONIC PAIN AND METHODS OF USING THE SAME |
WO2017200700A1 (en) * | 2016-05-16 | 2017-11-23 | PixarBio Corporation | Methods for treating incisional pain |
US11202754B2 (en) | 2017-10-06 | 2021-12-21 | Foundry Therapeutics, Inc. | Implantable depots for the controlled release of therapeutic agents |
US11964076B2 (en) | 2015-03-31 | 2024-04-23 | Foundry Therapeutics, Inc. | Multi-layered polymer film for sustained release of agents |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4166800A (en) * | 1977-08-25 | 1979-09-04 | Sandoz, Inc. | Processes for preparation of microspheres |
-
2015
- 2015-11-11 US US14/938,274 patent/US20160136094A1/en not_active Abandoned
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4166800A (en) * | 1977-08-25 | 1979-09-04 | Sandoz, Inc. | Processes for preparation of microspheres |
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11964076B2 (en) | 2015-03-31 | 2024-04-23 | Foundry Therapeutics, Inc. | Multi-layered polymer film for sustained release of agents |
US20170239183A1 (en) * | 2016-02-23 | 2017-08-24 | PixarBio Corporation | COMPOSITIONS COMPRISING NAv1.7 SELECTIVE INHIBITORS FOR TREATING ACUTE, POST-OPERATIVE, OR CHRONIC PAIN AND METHODS OF USING THE SAME |
WO2017200700A1 (en) * | 2016-05-16 | 2017-11-23 | PixarBio Corporation | Methods for treating incisional pain |
US11202754B2 (en) | 2017-10-06 | 2021-12-21 | Foundry Therapeutics, Inc. | Implantable depots for the controlled release of therapeutic agents |
US11224570B2 (en) | 2017-10-06 | 2022-01-18 | Foundry Therapeutics, Inc. | Implantable depots for the controlled release of therapeutic agents |
US11969500B2 (en) | 2017-10-06 | 2024-04-30 | Foundry Therapeutics, Inc. | Implantable depots for the controlled release of therapeutic agents |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US20180256502A1 (en) | Compositions Comprising NAv1.7 Selective Inhibitors For Treating Acute, Post-Operative, Or Chronic Pain And Methods Of Using The Same | |
US20170224621A1 (en) | Compositions For Treating Acute, Post-Operative, Or Chronic Pain and Methods of Using the Same | |
US20160136094A1 (en) | Compositions For Treating Acute, Post-Operative, or Chronic Pain and Methods of Using the Same | |
KR20160146669A (en) | Compositions of nanoemulsion delivery systems | |
KR20070057767A (en) | Phospholipid compositions and methods for their preparation and use | |
AU2016428204B2 (en) | Pharmaceutical compositions and uses thereof | |
WO1999012571A1 (en) | Nanocapsule preparations for treating intraarticular diseases | |
EP3253372B1 (en) | Preparation of an oil-in-water emulsion for polymer stabilized pharmaceutical formulations | |
CN101495148A (en) | Pharmaceutical composition comprising at least one anticancer drug and at least one polymer | |
CN109010269B (en) | Aprepitant fat emulsion injection | |
Domb et al. | Lipospheres for controlled delivery of substances | |
US20160136095A1 (en) | Methods for treating epilepsy or seizure disorders | |
US20160045439A1 (en) | Compositions for inhibiting inflammation in a subject with a spinal cord injury and methods of using the same | |
CN106913520A (en) | The particulate administration composition of Chinese mugwort Saperconazole | |
WO2017200700A1 (en) | Methods for treating incisional pain | |
DE102007062113B4 (en) | Dermatological preparation | |
KR101771483B1 (en) | Double layered polymer capsules with improved dissolution rate and stability of lutein, method for preparing the same, and pharmaceutical composition for preventing or treating ocular diseases containing the same | |
CN101252842A (en) | Sustained release enhanced lipolytic formulation for regional adipose tissue treatment | |
KR101764004B1 (en) | Composition for preventing or treating osteoarthritis, or for relieving joint pain | |
KR20170114245A (en) | Parenteral bioactive substance delivery composition based on low molecular methylcellulose |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |